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HomeMy WebLinkAboutBuilding PermitsPERMIT 268 5/9/96 5/9/96 LOT K-82 OP,�,`1s/"6 O'Conner, L. C. 369 Gt. Island Road West Yarmouth, MA 02673. Strip & re -roof SHEET 9 $3,500.00 PERMIT 747 LOT K82 O'Connor, Lawrence & Helen C-*a'` 369 Great Island Road olio West Yarmouth, MA 02673 Addition 2-car gar 221x211, 2-car gar. to exercise rm. SHEET 9 10/19/98 10/19/98 Q�-war v rqf!�, convert existing & bathrm., 2 decks. $35,000.00 OF Yq F Wrr�� i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 n E 11ALRM� Pi Rd (OFFICE USE ONLY) (Rev. aros) !'OF b b`�20UTII11 By / / Fee: $ `�/� • �� EuILo,f;C ZEPT. PERMIT NO. Fz- Ey (PLEASE PRINT IN INK OR TYPE ALL INFORAIATION) Date: 3 % — b� To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 3 (Dot ied,4�t� 4.'t^Ol_ � Owner or Tenant V�rs. kAll Telephone No. Owner's Address R� Is this permit in conjunction with a building permit? Q Yes gNo (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd Q No. of Meters New Service Amps / Volts Overhead❑ Undgrd Q No. of Meters ���p,,, Number of Feeders and Ampacity `r 1 1 Y� Location and Nature of Proposed electrical Work: [W V C \�AV, l i 4 21^ 1 OS� Vq S) L ,.. Com letion o the flowing table may bwivedby the Inspector of Wires No. oTt TOta No. of Recessed Luminaires d 1e) Fans Transformers KVA i No. of Luminaire Outlets No. of Hot Tubs Generators KVA Above n- ❑ Q o. o mergency Lighting No. of Luminaires SwimmingPool md. grind. Battery Units No. of Receptacle Outlets No. of Oil Bumers FIRE ALARMS No, of Zones No. of Switches No. of Gas Burners o. ot Detection an Initiating Devices No. of Ranges Ttal No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat mp Totals: um er — ons — — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Q Other Q Local Connection No. of Dryers rY Heatin Appliances KW g PP security Devices No. of Devices or Equivalent No. of Water No. of No. of Data Wiring Heaters KW Signs Ballasts No. of Devices or Equivalent No. H dromassa a Bathtubs Y g No. of Motors Total HP Telecommunications wiring• No. of Devices or uivalent V Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides n 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 �c BONDQ OTHERQ (Specify:) ((Expiration Date) Estimated Value of Electrical Work: 40 14a7 (When required by municipal policy.) Work to Start:21 --S'27 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and nalties of perju , th t the information o this application is true and complete. FIRM NAME Cie e - Lrro c LIC. NO. Licensee:Gtgctn (,mrv- Signature 1i LIC. NO. (If applicable, ente "exempt" in the license number line.) Bus. Tel. No.:�i5�77 I-222� Git_ 122 Address Alt. Tel. No.: Security System Contractor License required for this work; if applicable, enter the license number here: 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 war • this quirement. I am the (check one) owner owner's agent. ❑ Owner/Agent Signature F " Telephone Nd-64F9> 4 i \ , 'IFP'!0 L[rrl YF &Eros `-� LOCUS MN r some, LOCUS MAP GENERAL NOTES: 1. THIS PLAN IS FOR PERMITTING PURPOSES ONLY- Z. VERTICAL DATUM IS MGVD. FOR BENCH MARKS SET. SEE SITE PLAN. J. THE FLOOD ZONES SHOWN ON THIS PLAN ARE TAKEN FROM THE FLOOD INSURANCE RATE MAP PANEL NO- 250015 OOOS D. MAP REVISED: JVLV Z. 1992 AND DO NOT REPRESENT OR IMPLY A FLOOD CERTIFICATION FOR THIS STRUCTURE BT THIS OFFICE. I. BEFORE CONSTRUCTION CALL 'DIG -SAFE'. 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. FOR LOCATION OF UNDERGROUND UTILITIES. LEGEND ■ CB CONCRETE BOUND —I— WATER LINO O HYDRANT —6 WB LINE —OHW— OVER HEAD WIRES O. LIGHT POST —E— UNDERGROUND ELECTRIC LINE .. —T— UNDERGROUND TELEPHONE LINE —CTV- UNDERGROUND CASLEVISION LINE -} 10.4. SPOT ELEVATION • 1-10--- ;.•EKISTIHG CONTOUR - . PROPOSED CONTOUR.. N I AO V� 0 FL000 I W W.9E NOT AVAI. OLE 14" S1A41-mll IeRv "I.I a. EJEt IANI.l:G1 � �� :4-1010 AW Alll AF1[l MtAMi• is IRO IN HA'O TEP COA/TA: R4+err•. \i //•I/. �' a TIM i• •-- .fO S ,'r''/ jLl �stL� l s � as a6 10m .`olaY S Mf AAA•_.& L FJl l r,. ,t i 1R 4 r lVl t l m l,A 1 fAw,' .T IVR r" ON AA9 A -TV O:fOIfA I /:! IN ROUNAIN' L"llolt AAAAalI. LOT 82 / 19320 S S.F. allflM - , _- Ijof "a ! S } I /� IN-Oo.Aa mrA11-TC-' •\ \{. MK d EL-R.or MNgv . /r NMroItD.OERE I r� _ t\ r' If I l n F.SAoIm INIAN . - , • ,,C1- T. - AM IOlfrw ti •.AR 0 C/,PLw FlAaL\" � O � l P. . .8 . i i 0 10 - 10 CONSERVATION NO TES : 1. THE WORK LIMIT SHOWN SHALL BE FITTED WITH A SILT FENCE AS REQUIRED BY THE CONSERVATION COMMISSION. THE FENCED WORK LIMIT SHALL CONSIST OF A CONTINUOUS. STAKED. DUG -IN FABRIC SILT FENCE. THE FENCE SHALL REMAIN IN PLACE UNTIL THE DISTURBED GROUND IS STABILIZED COMPLETELY. PROVIDE ALTERNATE SILT FENCE SUCH AS STAKED NAYBALES IF NEEDED AS DIRECTED BT THE CONSERVATION COMMISSION- Z. N0 CONSTRUCTION RELATED ACTIVITY SMALL OCCUR ON THE WETLAND SIDE OF -THE WORK LIMIT. ` J. ROOF DRAINS SHALL BE DIRECTED TO SUITABLY SIZED. DRYWELLS FOR STORMS'ATER RUA OFF CONTROL. A. INITIAL SOIL STABILIZATION WITHIN THE WORK LIMIT SMALL BE ACCOMPLISHED BY APPLICATION OF MULCH AND/OR' LOAM AND SEED WEATHER PERMITTING- S. ACCESS FOR DEMOLITION AND CONSTRUCTION SHALL B£ VIA . THE STREET SIDE OF THE PROPERTY WITH LIMITED ACCESS�r AS SHOWN AROUND THE PROPOSED DWELLING SITE. 0. ALL DEBRIS SMALL LADED FROM THE SITE AS IT IS PRODUCED AND TRANSPORTED TO A SUITABLE SOLID WASTE ' HANDLING FACILITY. RtiP� S / TE PLAN OF- LAND G 3M59 OREA T / SLAND ROAD . MAP / 4 . PARCEL / WES T YARMOUTH. MA . ',PREPARED FOR: MART III /V RE/LL Y 22 MA / N STREET- HYANN / S . MA 0260/ SCALE:' % 20 ✓LINE 30. 2006 REVISED: JULY 20:'?OOQ REVISED: AUGUST 7. 2006,:. EAGLE SUFRVEY I NG I NC fl23 Rout•.6A - r—� Yormouthport. MA. 02675 (508) 362-8132 (508) a32-5333 . 1 JOB N0: 04-114 *FIELD:CFW/EEK CALC: SAH/CFW CHECK: CFW DRN: SAH 'n 3 EX15T. I rwr. µ.ry I REMODELED b DECF, 50LARMNA Y„' °r rr)IC. rriylnG RRnrK. IX]Jf� (> VI• ' oK rer u(� fn lrrtrl itw [:�,r5 h5'YnM"r AnfRr�[N ArEttfYM WA: LOLfI rwG 4UL_f fnvr EX15T. 0 I O DECK po REM e�Exrb[r, EXI5T. REMOD. I \ /l ©A1F1 me L•n"r DINING PM. KITCHEN I C_C UF:OOtiI RUu�i •� lv llC°arrx.l vmrr um, 1 /°� I•lv I :irp A•IrI N(N GP1 rrno rwr fmrnnctlonr• I P,EMOU.I AA'R^ V i,tJu in rTN ❑(w rYA!.mYY. , rP LAV.. �I(�Q I � 'S 1 `� nrExrSrn (r^I n •' rt��}[nm r nr: nonu• a v.• • ^ Iwrn •C, I]ADVI[ n1ALInAEU/rl�Lw'niU:Y.I•xw1 r- 1iALL / nvG crcEXPANDEDLIVING RM. REMODELED r(Nulmcn.G STUDYN eN W'Clio r A jsr q ra NEW A PORTICO • Nw I(: rNn - A I � I pr,•'n..l FIRST FLOOR PLAN GE"ERA`NOTES: I.) COIJrPACTDP- t5 TO VERIFY fX15TIIIG COItDITIDHS AI IU fIPST rLOOR 23 S.L [MIST. fIF57 DIMOI.-40t15 III THE FIELD PRIOR. TO THE 5TAFT Or % N EXIST. (LOOP, - I200 5.r.. LO%TEXIST. GAPAGC - 528 S.P. ' , 2.) COWRACTOP, TO P.CMOVE EA5TII Kr DOOP5. VA IIXX%R:, IIr.W FIRST FLOOR, - 12; 5.F. ' WALLS, 4 ROOFING AS RCOUIRED POP IMW COI 15TPUr'I".11. IICW GARAGE - 2G 1 5.F, 3.) ALL NEW CONSTPUCT101I TO MATCH [XI5TIIIG Ili MAI[VIA'. DETAIL AND FIN15H. LEGEND 4.) ALL WOPA SHALL COHrORM TO THE MA55ACHUMITr4 STATE BUILDING CODE AIID ALL OTHER ArPUCO•IXf O CnSTU IG WALL CONSTRUCTION TO REMAIN LOON. CODES AND , O NEW WALL COII5TPJICTION TO 0[ RISTFW CTI AS PEP 5-) ALL IU W GAS ACZ5ORDINT Of CC7 CXISTII IG WALL C0115TPJJCTION TO B[ REMOVED ER51IACC5 MMIUfACTUP.[RS 1NSTALIATIOH IIJSiPJJCTl01 LS. ® NEW 5100a DETECTORS VEPJrY ALL R,COUIRLMENT5 IN T11C rim. TW,rjan r/NEImMon - R NEW LIDP.ARY/ FAMILY RM. , - r:rnnuu rlw., I I Ixr r.Irw T � Hurt: Al'lA2 Qra I dnl�flta• I.IV N — ° 1 I IWALF IN I ICL05ET_ I I REMODELED MA5T ER DEUROOM r. Ni"iru rr n n+ F 9Y'f ' •' DECK WINDOW SCHEDULE _ TrrC MANUfACTUREP.'5 UIIIT ROUGH OPCNIIIG R[MARrS A AIJDCR5EN TW 2452 2' G 1/8'r 5'-f 7/6' oOU5LrIIU"G _ CIRQC TOR rP01IT DOOR B CTCX2 5'.31/4'r2'-101/8' C D TW 24310 TW 21042 .2 2'-G I W. A'-O 7/0' 5'-11 7/8'r W-4 7/8' DOUBLCHUNG DOUBLEHUtIGIMUILCD)Y.%TrMP[P[OGLA55 E CTO 3 G' O 3/B' r 3'.2 NA* CIRCLE TOP r CH 25 3'.5 114' r 5'-O 3/5' CA5EMENT G CTOA 3 3'-O 1/2' X 3' O Ia. DUARTCP. ROULID _ tl SE L03 G'.O I ' x 5'- I 1 15/ 1 G' 5rRI, LINE OP,Cl2TOP Wu1DOW J CR 25 2'-10 14' r 5'-0 3/8' CASCM[I!T IIOTE:COIITPACTOR TO VEPJFY ALLOLIANTITIC5 MID 5IZE5 Or N Nww Win vr+run.•.:w •+.�.+• • �• -••^ WITH WINDOWMNIUrACTURER FPJOR TO OPDEPJIIG OF WItIDOW5 (REVI5ED:7/ 14/2000) [a L` WW co � E-� I i �Lo a N O U Inco Q z�� h-1 in � A W a da O rn A r- Q�-I `Y 0�m O A F 0.1 O E O W A zzz o�vJ N�y t-4 F A••1 E Qi O co SCALE 1/4 N = I 1-0" DATE : muanoraa 412GI2000 J`AI )0°6 PROJ• NO. 25-9212 DWG. NO. uAnx �ikrtE LM[ . A 1 w 1anEu ! ( •2 Eb' NhY EMIR o wt 51�4 114� '--r,Mllri co In law pry czrmt LA 0 U co CID 'um�IA* . . . . . LO= � i. to 0 P� MWTE :3, z Lr) j, P1 Imle, "Rr..% A4 t I 4 . julum -94 0 co FYI 7r. t I Q.. MTMf XIA-r! z v{ lOy� FRONT ELEVATION 'Z r co 0 E-+ P4 0 23 c r- - - - - - - - - - - - - - - - - - E-4 NEW 5TC)= EXIST. BATH EX15T. JA BATH NEW DEDPOOM Z Z z EXIST. 0 0 E .. MEcHJ �E, MTN' 5M.F1 LDRY NEW E--4 1 10 CL PfFnfP AIN ?J`If"-EU NEW GAPAGE I WIPI NfW 19 PIA, uw'D EXIST. -c::� <� E� EXIST. b -C4 FAMILY RM. GARAGE q > -W.9 lwt%lL EXIST. 0 HALL z 'w" To NCW c CD cri F C. c SCALE BA AREA 5 ftm 0 mr 1;Pw 97. TV 0 V" 1141= 11-0" N W b F CIO. t'l DATE L4/2G/20OG IFT Kc, L� PROJ. NO. I 25-9212 'y DWG. NO. I GROUND LEVEL FLOOR PLAN LEGEND C= DnSTRIG WALL C0115TRI)CTI0II TO U"N C=) NEW WALL C0145TPICTIOIS co ErSTIIIGWAiLM15TPUCTlOt4TO15EFEMOVED I (P,f V15E[):7/14/20(Dra) I lYWfh rn1 . J t:PV 1 1 a"71 DIJ•IL "_.—.7_.-- - r-1 REAR ELEVATION III Vi V•f: r•rvlci Imry e�MAC M1tI.. r ti lf."Lt M1I.11:1 (r, 'fl. rrrf r:r./ • 1 Y//' 11/p /.Cr4 / • -� r:IfW 1 J rr «i rw ru . I nS rniYfu ' t CY"l it .,XW act. r"•^r•.r,a w"', illy IA - -. gm x •jI1111-AC9 1.A 116V' 1 . Y I • G �+� J I � t� 1 1 , / I - . I r I ,+•A �++. ' I � , / !+ coair txarnrY I — �" i ..i i � •I i- _�_._ 1If ♦rta Lj u"," EElio" I '.� �n d 1 ..--♦. 1. } ( f : 7 -r I ♦ ■ I t I - wt, O aTxr. i L.��. r 1 111. '• 1 14M1 1.' fM rRW 1 f [, r.et:N 1YY•rp — -- _ _ Ilrvl rLLT,r I I l�LPf,-- FL � I : I t.111( II a �r:r•. IOMr i Y. Y 411 1 ` ._ 1 � 'li rT I 11 CA, 1/lri rlN i t i r_ 1.. t t._ I �Y i 1, r 1 t .Ph • I.1 .. _1 J rYlnl• - (rtn�i'I •/..y.t I �. •) [ frftx vnr!Y Irn•, P •IrIL` � r � 1 `• I ` r...:` J � Y hiN��•I I ' 1"rr nl nCt^.^Ul .L1i"J L 14.IiLU LEFT SIDE ELEVATION RIGHT SIDE ELEVATION5 ,4 -4 �Wco F 1 u IF aN O .. U w w to O zfffiLo Ur v A A W 90 W W A F CD 0 02 z O 0 O A F L1. rQ �Fr.1i W F O W � � � A Q' FNN � O W 011 E 00 PROJ. NO. 25-921 2 rt4 DWG. NO. A ^ (P,EVI5ED:7/ 14/2000) FOUNDATION PLAN GENERAL NOTE5 4 MATERIAL SPECIFICATION5 fOUPIDATION`i: I .ALL Y.T)P.6MAII SHIP TO C.OIIPDRIA TO THE FET)14FEI.ICIfTS OT 111[ MAT•9nCHUSC7T5 STATC BUILDING COD[. lATCST EMTIOII 2. POP.'_47C LCY'ATIOU A11D GPADItIG INPOPWAt101I, 5EE 5IT[ Fl &f111. DY OTHPF5. 35AII�GPA,nL MPV05R� IFOMPACT DACT. TILL 5,2"IS APLIq D F�IM[TOCP,%I A DI.ITD. VIDPATOPY COMPACTOR.. ADD .,V [WGPAYLL RIIV AS P[OUIFCU DVFJI If, l:C"ARACTIOII TTI FPI7VID[ FII IAL GPMf.. .1. CDt )CFIT E- M1i11iAUM 2B DnY STP.EIIGTM, Ir 30(10 �'" LA' AG{.P[GAT[. t'[5"a ICD PCP. AMEPICAII COI ICP.LT[ Itt5TITUT[ A.)5TE[l PLII ITCW.ONG DAPS: IIEW BILL[T STEEL ASI to A C,15. GPAP[ GO p J AIICIIDP ff)LT5 A5TM A 307 6ALVAIAZED. 5/3' DIA., 12' LOIIG. %1 2' NOOK. SPACED AT 4' 0' n.c. MAX. 1,. O' TPOM JOGS UIILE55 DTTIEP, W15E NOTED. C.) V6VDCD Yr1P[ RABF.ICG "TM A IDS: RUFJ115H PLAT SHEET5 PIACE 114 TOP 1'. W W 1 CC) 1F'1 I ✓ 4J M/y 0 1 y cQ O /\ U c0 co Lo O z4U-) � v ul � A W a aj A r . N A C vi z� 0 A H a O 5CALE : 1 /4"=11-011 DATE : 4/20/2000 PROJ. NO. 25-92 1 2 DWG. NO.__c (REVI5ED:7/ 14/2000) NEW POOP- CON5T. — , Q'^ i'. rUI1rV IIIIfI.i if 1.'r \ W I:J' [n• rt,..:. PYr I(1 n n.R Plrnrl'. I flr (!1:/r lrrl rJTr.!'Y •'� CO rrwillf'. IC t:M 1ptif fYrV rn.l [I 11111'rM1l: 1 � [] w ry In Y Mil rl-IRA'n'1rl � `[-"'1� I LID w +� cR2n nn err R'• 1P[ lIw7I31V'•^IH•IVt 1FH}.� '•'N`1rH.Yrr [I r •t J..r, .1 J.rp, U,.: n, 4! r'IY.L M.Vr11 r.r(Rlrl P1"rl1 n/rp earl CIQ I4 �I`N Vwmtlk ,F _1 CO co EXIST. ROOF \, I'""°T��• VLO C) / GONrJT. Pllnp 91 re\ n.. r •r (, o•IIt �MYPIRr •.qa ` `,\ 11 a IT �- --1 r• In.. Z ~ Lr -r 11 1 •.rl,w li: r[ \ rl Art. 'r•. 11[n 1.)r:rr N: rrl T:I:alir IYrIr1 r^ .n ......, W EX15T. WALL EX15T. WALL A EXPANDED 1 EX15T. GONST. P,EMODr EX15T. PEMOD. REMOD. REMOD. CO JFIT, i W LIVING RM'II1' DINING RM. fOYEP, HALL LAV. BATH SOLARIUM �. �'..«.+ .• ; I, i� t .. rllrall �.� lT�l llrlT •ary r tirL.rtr.T A IN 1411N1.IIIM.T IIM III rw MNYYrfr[Irll Il 1r ,YI"11'.I .rIrF_O 14'o� IrV .I'Ir.r.-.'•_ -- rYnnrl'IYrlr•,•1 �r(M'N '•(I xr lrll[rrY U I1r I •I • -�IT\I 1 rrl�rA'1 !`TIR1:1 Rr 1! WA Q(' ' I' 1. • - ZEn 0 • 'EXIST. • .1. •, nv,A . nr..Rr . ,.• CXI$T. II•M• EXIST. GQ FAMILY P.M.' i Ir.v nnm. �• Ur Inrxn'rrlr HALL C.LLY. OATH •. YIR.rr Ir I Ir .4ll xlnnll-.+-- F•IIR.'I'Yr'Ir. yJ O r.1AVI1- W r•ri O a [v1;rl,IMIICAIYRi u/.ILR �;t t •.'i 1 r'� tt•'••II r� ArN r1J(114 ii 11.. rr4NI1 � ' r •XM n'. IIII I•r , IrTln!i1A11 HI W O J.1 Ln• • iM'rt lR nr» � � '-rnnY♦rc•. M41L Nx•• 1 I--I'1 wx1 IIw c -• 1rr•I. i BUILDING SECTION @ REMOD. FOYER ;�,€;;al ,l•. �A�I tn inA •rN rtrn• +r r•�lr dxr IN car \\ fete. r•f 10 r.yrl%t(nY 6R4Y � - A5 r 1t:., Il tYrr Py rPAry nBUILDING SECTION.@ EXPANDED LIV. RM. (\ All[I I[Ir)iI1Ni4111 ptW I 1`1�-'-�� 1� O NEW P.00F CON5T. r Ire FM1r Inl lie. R II•n r rrrl11 gml•x•nI r .vnunr: I RIn Inl rnm, /--' NEW POOF GC71J5T. R rn r Nn Rr+N Ntnl ' R-N1R21111 [[x'l11•Yrl � rrll•nlrV rlr,tliw lV n• • "Mll Hein nln rl IM'r /YIi N•r I'nll / I.�f.fti llYwtrlL�I2r R•V?.irbr /Y' H (11111RRY^-IY. iR 4'Ij'VYIY "ar (PY� rll•lrl`M lrrl MlN'i L'[ 1^r, rnrnlru nn r. r•IVAr IIrI � Ivrw .In rAn1 1-1 • r I:I.IN nl rru al mYC Men RIR•MlnraniR+l O fx1ll `n 1 1 fw;.r". r 1- r-MrM.'t rR•l l'.•I:rI 1V•1.1 I ` IP'Y n.nnR lc'wr � 1••-i I r.,WRnr a! v-.. `rRr' 1 :•'f.r M l[I 7� Ira •.I I,rrN.Y.'IGOr O rlr�\I 1 p :. [•.n I PFlr�l n+f IT I, IV �p.l jlrrs lM[vt'• ... .. .. I -- M.nl wa'. I .aarr •rnl'• H.rl ,k P.EMODCLCD NEW P(MODCLED NEW UBP.ARY/ r r FAMILY P.M. •a NEW MA51tr MA5TEP. 13FDF 0%4 DEGK BEDROOtvt BATH 6fDP,00td DI ryr[q r0.lR . ; .. i' I 1 •. I � Ilril 11 ([1 VRVI(,rn'r .. yrrrr.l • •r`�axtl ri�•rrJ.AIIM:1r11Ir111N MI1rrM Y2L:rl l n'J ULIULIV ( I`I'"r111r-I•.r Y- I r P( sfa-ml. WI mIN, YlrY lr4 r 1 Ml J ........... 'AI,TI.. I.I RIFMrr1 r, ) n r(RT LIr ro. WMT1 R[4tt Alrll \-5,r'nM1r lxr(rrr M rYJ 'v/ RT WAILi(II frARAr{ w.m Al Wn4lrr VIA'r •. • .. .• _•• l• 1 r W NEW NEW WALLGON T. X EX15TING ' EXISTING.:: p 1 GARAGE .:12•nlw[xnOgrAns. I GAP\AGL GARAGE P� i'•' ..I,rMr1RwA,Ran•Iv 5CALE w 1: ro . c NalRlrar arnc 114 R= i l-On • .Tn2r i__R rJ rl_. �n 41-7 -- DATE _Ilrr, 11 ttrr i i—rP"1':R.IaH(( `:rt 1. __ fnY, FG•N O•ra,?�If' 412GI2000 ![.1r10A,UlYVJI • j�rl<I'W!(��RUbi 1"r r.} 'I r • A•II1 PIr 11.rY/11rr ••[Nrl Illw Rrrr•11.._rve Yell 11`; A<Ir IY„';�6: �x _�1.f PROJ. NO. ICR nYR:1 BUILDING SECTION @ NEW LIBRARY\ FAMILY RM. BUILDING SECTION REMOD. MBR nBUILDING SECTION @_REMOD. MDR 25-9212 AA.,W DWG. NO. A 5 (REVI5ED:7/14 M F11 •„ rMrt• r ROOF DECK FRAMING PLAN ROOF FRAMING PLAN I0"; ALL I RN' POOr PAITCP5 TO BE. 2 . 105 f) I r' o.G. LR ILE55 OThr. PA 15C I TOTED GENERAL NOTE5 S MATEP,IAL 5PEcnCATI0N5 FRAMING: 1. Ill F',.rJ rMl `i1M lrJ r lYX IT1Alll lllr n:nlRl'FR'tn<IX rl\ I.Y:MIr IR[r,l•. nrrlp N\ I'pY: ([II IpT^fl f'X1Y 11. i lllAf[R nA!nn. NItYt 1iA, ILL - Ito.:'AYIMrIn'II iN, rl• 1'TrlrsI 1 v)r.T•r..,I, niixr I1nrntpTrtnnrl•m.RYI Ip T L.:✓\nnl "I me VLMInMI I` I1*r1 urn!•!It I •I"l I,nVT[I)Vlrrt rf1I An'!, rll LVIrp M IMIN,V II 1)r I:Il M11Frlr rl•�411Pl1w.1 1nrVI.h-:n41n. I•ITr-TMr II,ToI •'r1,RI, rAP-rr, I'MI�IIII") ",VN il11 tA,r,, r1.. lr MI, gr`i.lrp.11J rr. 9'rr p.. 1r ITT. -tr) fJ, fp IXI- i'r.!' n• IRlrl 1nX1 YYr nRrrr Nll fnfM�XU 1.•rrry Ifdll pITrM VrI INV I. 1 RZ, C!vrptfs X:i W MX rr, 11 Mr rs I I"I". Mil 5Tr1\I. in / 1) L•XLI n IlXrp\ fn rlpl rO1X:l(n ll•' •. V'prM Tl Il I Il ll.011 ATrn" � IMn N L INX IV IrR 1111'f1. Mill 111[ tAT IY1 M rYTI Ir ["'.T•rrpl I "TV M Y1 I1 F(I n n4\Y6 N" M Sul lry..11 wu ml 141 '1 U r M'AMM"•r9rn n T t II I YI nM PI sl Wl If rf r\..... n'\W IIrN[Ifn! M)MrI�lY MT NII ntTr VvAwp1 rn MRA;y V11 W Y.r 5 •l PUCTUPV ru-rAl MAI nr IYrL•11Pi•Y MIIL[TIIG r✓MrIIIn1 IrR II YM [F 3rC)vIIrll W . rs rJ nln l.YM Trl rtnY Al 151 llq» . RO IN FYn1 IrYU . it /Xl Lfl rll GARr1Y f.. Ml!nY F. IVrn/nY. �•Irll IIt MTR1 N:lrrnp. i.tlnwYlM,nf fl91 fr1.1H �. 1.\A1Vf 11 •11111+F'M I. 1'nRM. Nnrnl. rrn•i r•... I.MYMRU IrY+11 t n,nnr.. 4;IYInnh N \rtn ry(YrnY. TfINM1TN: if.l T!rl NpS rN.n �If Nr\I rY. NI;'lrn NUl.r. nM1Mbn;L,l [NIT BL',(Y i. rf LPC we•.r M'n [14 T IN,LIr,!M,nn l�nf. /II P%oLN WrNM1r1:WVILIIJ'Fytn)f11Nr[Cfl IV �1 sl )+1 MIr,_f.Yl. in, p A9 RM[n Ir[ul .`rTCrrl ll • • nU IMn •1 YI)11 n L (11XI.pl VI IMC1 F xln rr+rr Mrn, wnn vl,lu)•lnn Flul C WV1NTf T"Al M1dwIA C. II [! IV)ITfI q, Me rrn Y!T qI % 1. N1 fTnfH nRCF'.Vn\MTs sT)Tf N,IINI/ II+IY TNY! I�aY. i!. IYRXIMpf rrI lrs w, In PrIrw,,Il, :a TllrR•4 IV RXIf. 1p 111 nnrr PN11n1:1 WIN., _.t IL�.M!•!) T lrp �1RU11\ PAN 4'Nf fIAwC'nr, p♦w lftn,rRrY'nlrl` ..14 ." w co I Ln a CQ O .00, U co co Lo O z4LO UI v Iti A A w O O co a � A CN2 z V' 0 W o� A F no O E-1 O a O f=+WA � a A z O O a �WN 5CALE 1 /4r= 11_01, DATE : 412GI2000 PROJ. NO. 25-9212 DWG. NO. (REVI5ED:7/ 14/2000) I S� ,, (,� I J U61 q 101 I (K TOWN OFRYgR�JVI , FEB 1 r r tUILO114 111 ay: _ _ Building AT: Location 36 Grc�sr kv % I. -In h t+. o u -\ \ �A New ® Renovaticin Plans Submitted Yes Q/ APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) 1. 1 D By Fee: $ 07 '07 G� PERMIT NO. r. Date l Z o2 d 0 Owner's n� %,/ NameNat at h Atl 2- F I L� Type of Occupancy D W4--\ 1 t Ng Replacement ❑ 1�6777 l�, ' / N N W rA LLB' I yU) ¢ VO Z cc N S cc m Cn 0 J_ O W W } Z = M w - Q m W FW- W S W Z O F- O _ to a0 O O> F- W �z� cc Lu8 1910� W -WJ'a¢� >y m z o SUB-BSMT. BASEMENT 1ST FLOOR , t 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) (� Installing Company Name _� h . 5 co P Address 'I I R - 0- U! L Check One: ❑ Corp. ❑ Partnership — M &IF rm/Company Business Telephone 4 b 11 Name of Licensed Plumber or Gasfitter -� o ti C 0 INSURANCE COVERAGE: Check One I have a current liability Insurance policy or its substantial equivalent. Yes Imo ❑ If you have checked yes, please indicate the a of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under Permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Signature of Licensed //Plumber or Gasfitter License Number TYPE LICENSE: ❑ Plumber 0 Gasfitter 0 Master 111dUl'imeyman APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 (OFFICE USE ONLY) (Rev. 9/05) BydM�]_l�B Ibq e. 0 u U b Fee: $1()o 10e) •FEB IIII 2 $ 2001 U thisl=-aEpFpnit-ca-�donah=ndersl�ned PERMIT NO.(PLEASE PRINT IN INK OR�'E.�A-9NFORAYAT70) Date: oTo the Inspector of Wires: By gives notice of his or her int tion t perform the electrical work described below. I Location (Street & Number) .� E cl Grep L 1:_y, .+J %Zd a,Owner or Tenant 'M A (' L iJ 12 e- I Lmot Telephone No. So$ 2 914 S 36 Owner's Address 2Z Mc4rJ S'F HI to„.i Z OA60 1 Is this permit in conjunction with a building permit? 0 Yes ❑No (Check Appropriate Box) Purpose of Building Utility Authorization No. IS S7!Ys � CExisting Serviced Amps O °Volts Overhead❑ Undgrd OL No. of Meters 1 New Service 220 Amps 1 / U / Z2�+ p Volts Overhead❑ Undgrd � No. of Meters 1 Xurnber of Feeders and Ampacity yLoation and Nature of Proposed electrical Work: ipc_ QjNJ H 0 OS Ser %) i Cam letiono the ollowin table mavbewaivedb the Inspector oWires ON. 5 C� No. of Recessed Luminaires o of i - ddle an o. o of Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires ove n- Swimming Pool md. ❑ rnd. ❑ o. o Emergency Lighting Battery Units No, of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No-. o etection an Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat mp Totals: um er — — ons — — — Ho. of Self -Contained Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Munic Local ipal Other ❑ Connection No. of Dryers Heating Appliances KW $eNo.toSystems:* Devi es or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Ilydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or uivalent Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides W of of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in �y fore , and has exhibited proof of same to the permit issuing office. ,C CHECK ONE: INSURANCE (a BOND[] OTHERQ (Specify:Z Zo r-% c (Expir on Date) ;Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application true and complete. 0—FIRM NAME LIC. NO. Licensee: Qom/ Signature LC. NO. �SJS % D '' (If applicable, enter "c emgC in he tense nurser lin) Bus. Tel. No.: Address 2 LeA /l S� S'n n .lw i OZS Alt. Tel. No.: S� 4 is+ Zi'0 5/ S *Security System Contractor License required for this work; if applicable, enter th icense number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the ability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner ❑ owner's agent. Owner/Agent Signature Telephone No. WPS - Permit Page 1 of 1 NSTAR WPS - Permit Utility Auth/WO #: 01574434 Date: 02/28/2007 Company DAVID LENTINI Rep: Report By: YAR Status: ACTIVE Service: INCRS Type: RES Nature of Work: UPGRAD 100 TO 200 AMP UG TO POLE... ADDING 1000 SQ FT ADDITION/ JACUZZI/ LITES/PLUGS.... NOT RELOCATING SERV... NEEDS SCH DISC/ REC... NO FLAT FEE QUOTED.... TO BE DETERMINED AFTER DESIGN... RESEAL AFTER INSP Service Information: There Is no Service Information. ff E07-799 Meters: 1 Reseal (Y/N): Y Date: 04/17/2007 W10060 Description: Search ( Detail � Contacts Copyright 2003 NSTAR, 800 Boylston Street, Boston MA USA. All rights reserved. Reproduction In whole or In part of any graphics, Images, text or other content at this web site must be granted by NSTAR, Boston, MA, USA. Unauthorized modification of any Information stored at this site may result In criminal prosecution. httpJ/www.nstaronline.conVapps/wps/wpspcnnit.cfm?Page=Permit&Unique={ ts_'2007-0... 4/17/2007 . I TOWN 0 ARMOUTH RECEIVED FEB 12 2007 NG Building AT: Location 3 &9 G ,tya APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) Fee: $ d-19 IQ PERMIT NO. � 0 /f / 7D Owner's Name_ 14uw4ji A icl it ` Type of Occupancy D v c'- I0 New S2 Renov�n) Replacement ❑ P— Plans Submitted YesW No❑ I�o1 PU1�- Z N Z 3I d% N Y Q a y O Y ra- z_ H O O O zz 0 as vi O Vill, iz y y w 0 F, N w x a f" Q W y N Y Q R CO U. Z o. ga o v Z � m= w a w v, r a W w Z G � 0 Z a. J LL w= a 3o z i3 Y a o u) a Z YQ� Z w� F- 0 Y U w x Q Q Q=~Q Z O O Y J m N 0 0 J 3 2 Fa- to U. O O G a o: m 0 -BS BAS ENT 3 3 I FLOOR ( 3 I I 2 2ND FLOOR 3RD FLOOR _ I,✓f11g1 -ro DBGw MOT �trllo PdriTab / G' -r s��W(sI Installing Company Name t p ❑ Corp. Address 3 �nb-0 - tNIL LN. ❑ Partnership �rt-11r►noJ`i�� I MA D`2_rP-13 �m/Company Business Telephone 21 4 ` �3(1-7GI I Name of Licensed Plumber T � t INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes ®� No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy & Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature otOwnerorOwner'sAgent I hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent ❑ ire of Licensed Plumber License Number Type: Master[] . Journeyman2--� RE -INSPECTIONS RE -INSPECTION 2ND RE -INSPECTION DUPLICATE WEATHER CARD DATE: ADDRESS: ISSUED TO: REASON FOR RE -INSPECTION: BUILDING DEPT.: FIRE DEPARTMENT: GAS: OCCUPANCY PERMIT: PLUMBING PERMIT: OTHER: $30.00 $40.00 $25.00 FILED W 1TH T PETITION NO: HEARING DAT PETITIONER: PROPERTY: MEMBERS PIC Richards, Mr. Si Doc:17055s232 01-31-2007 10:00 BARNSTABLE LAND COURT REGISTRY TOWN OF YARMOUTH , BOARD OF APPEALS DECISION 07 CLERK: September 27, 2006 94069 September 14, 2006 Martin T. Reilly 369 Great Island Road, West Yarmouth Map & Parcel: 14.1 Zoning District: R25 NT AND VOTING: David S. Reid, Chairman, Mr. Joseph Sarnosky, Mr. John Igoe and Mr. Steven DeYoung. Notice of the he ' g has been given by sending notice thereof to the Petitioner and all those owners of property as requ' ed by law, and to the public by posting notice of the hearing and publishing in The Register, the hear' rig opened and held on the date stated above. The petitioner see cs a Special Permit per bylaw §104.3.2, in order to extend a pre-existing non -conforming home. The property is in the R25 zone. The lot contains an area of 19, 320 square feet, and an existing single-family hoir, e. The home is undergoing extensive remodeling at this time. The design plans call for a front -door "port co" to extend about five (5) feet from the front wall of the structure. The portico would then be only 24' f 7om the front lot line, where a 30 feet front setback is required The portico, as shown in the petitioner's pl and photo -quality rendering, would be as open structure, providing a roof over the front door, but no adding any interior space. The Board finds that the proposed extension would not be substantially more detrimental to the neighborhood The portico would be an attractive architectural feature, not affecting the use of the site or structure. The lot appears to have the benefit of substantial additional space between the private road surface and the ro layout, making the encroachment area less of a concern visually to the neighbors. Accordingly, a in tion was made by Mr. Richards, seconded by Mr. DeYoung, to grant the Special Permit, as requested The members voted unanimously in favor of the motion The Special Permit was therefore granted No permit shall is ue until 20 days from the filing of this decision with the Town Clerk Appeals from this decision shall be a pursuant to M.G.L. C40A §17 and must be filed within 20 days after the filing of this notice/decisib a with the Town Clerk. 1 In 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 �� 4gyg (OFFI E USE ONLY) TEJUN INW � UTH Bt e: $ � NW U 6 2005 PERMIT NO. 2� (PLEASE PRINT IN INK S TION) Date: CD' To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number Owner or Tenant 44 le Telephone No. Owner's Address Is this permit in conjunction with a building permit? ❑ Yes QNo (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead[] Undgrd ❑ No. of Meters New Service Amps / Volts OverheadQ Undgrd ❑ No. of Meters Number of Feeders and Ampacity CC Location and Nature of Proposed electrical Work: CamDletion ofthe follors-ine table may be waivedbv the InsnectorofWires No. of Recessed Fixtures o o. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above n- SwimmingPool md. ❑ rnd. Q o, o Emergency g ung Battcry Units No. of Receptacle Outlets No. of Oil Bumers FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Total No. of Alerting Devices No. of Waste Disposers Heat mp Totals: um er — — ons — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local Other ❑ Connection No. of D rY ers Heating Appliances KW g PP Security Systems: No. of Devices or Equilivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wng: No. of Devices or Equivalent No. H dromassa a Bathtubs y g No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent Attach aaattionat aetait y aesirea, or as requirea vy the inspector of tvtres. 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 cc 'tiesythasuch coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE — BOND[]OTHERQ (Specify:) am irwhwl Ezprn ate) Estimated Value of Electrical Work: (When required by municipal policy.) ra Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, undear}�B99alt�es� tha .t �� fottnadon on this application is we e and complete. FIRM NAME: r ((��ff�%ffL/><J()� J Licensee: Signature (If applicgW;,Aptcr_"exgmpt1' in the liceW num4erJsic.) OWNER'S INSURANCE WAIVER: I am aware that the Licensee does b below, I hereby waive this requirement. I am the (check one) owner O 1�1i� Z All .�@ have the liability insurance coverage normally required by law. By my signature owner's agent. Owner/Agent Signature [Rev. 04100] Telephone FILE COPY TOWN OF YARMOU BUILDING DEPARTMENT RECEIVED OCT 1 3 2006 BUILDING DEPI By: NOTICE TO THE BUILDING DEPARTMENT OF WITHDRAWAL OF LICENSED CONSTRUCTION SUPERVISOR FROM PROJECT 7A.2 r %'� CONSTRUCTION SUPERVISOR LICENSE # 00!f 393 I HEREBY CERTIFY THAT 1 AM NO LONGER THE CONSTRUCTION SUPERVISOR LISTED ON THE APPLICATION FOR THE PROJECT UNDER CONSTRUCTION AS AUTHORIZED BY BUILDING PERMIT # Fs-o7- 22� ISSUED TOjJAt 1-P e7 ON f� I 7o Doi ALSO CERTIFY THAT ON 130-0 6 .' 1 NOTIFIED THE PERMIT HOLDER, THAT THE PROJECT UNDER CONSTRUCTION MUST CEASE UNTIL A SUCCESSOR LICENSED CONSTRUCTION SUPERVISOR, IS SUBMITTED ON THE RECORDS OF THE BUILDING DEPARTMENT CONSTRUCTION SITE T l e400 124_ MAP diy / PARCEL LICENSED HOLDER DATE: FILED WITH TOWN CLERK: PETITION NO: HEARING DATE: PETITIONER: PROPERTY: TOWN OF YARMOUTH BOARD OF APPEALS DECISION - n \ag O/ September 27, 2006 - i #4069 September 14, 2006 Martin T. Reilly 369 Great Island Road, West Yarmouth Map & Parcel: 14.1 Zoning District: R25 MEMBERS PRESENT AND VOTING: David S. Reid, Chairman, Mr. Joseph Sarnosky, Mr. John Richards, Mr. Sean Igoe and Mr. Steven DeYoung. Notice of the hearing has been given by sending notice thereof to the Petitioner and all those owners of property as required by law, and to the public by posting notice of the hearing and publishing in The Register, the hearing opened and held on the date stated above. The petitioner seeks a Special Permit per bylaw §104.3.2, in order to extend a pre-existing non -conforming home. The property is in the R25 zone. The lot contains an area of 19, 320 square feet, and an existing single-family home. The home is undergoing extensive remodeling at this time. The design plans call for a front -door "portico" to extend about five (5) feet from the front wall of the structure. The portico would then be only 24' from the front lot line, where a 30 feet front setback is required The portico, as shown in the petitioner's plans and photo -quality rendering, would be as open structure, providing a roof over the front door, but not adding any interior space. The Board fords that the proposed extension would not be substantially mere detrimental to the neighborhood The portico would be an attractive architectural feature, not M'ecting the use of the site or structure. The lot appears to have the benefit of substantial additional space between the private road surface and the road layout, making the encroachment area less of a concern visually to the neighbors. Accordingly, a motion was made by Mr. Richards, seconded by Mr. DeYoung, to grant the Special Permit, as requested The members voted unanimously in favor of the motion. The Special Permit was therefore granted No permit shall issue until 20 days from the filing of this decision with the Town Clerk. Appeals from this decision shall be made pursuant to M.G.L. C40A §17 and must be filed within 20 days after the filing of this notice/decision with the Town Clerk. avid 9. Reid, Chairman Board of Building Regulations and Standards Construction Supervisor License License; CS 80556 Birthdate.' '4/23/1958 Explration:'412312009 Tr# 13923 Restriction. 00 BRIAN W RODQALPHy= ' 7 FIELD ISLAND POINT ,; _ SO � SANDWICH, MA 02563 y Commissioner ' APPLICANT FIELD COPY R-d/ - BUILDAG # PERMIT D T—r vw�•o:T'j�T 'r�ool PERMIT NO.- B-01-561 Garneau Jr. ADDRESS 251 Woodside Rd. W.Barnstable_KA 02668 (NO.) (STREET) jff6q7q(4CENSE) PERMITTO ALTERATIONS STORY ITYPE OF IMPROVEMENT) NO. Richard P. (PROPOSED USE) NUMBER OF DWELLING UNITS AT (LOCATION) I4(- Great Island Road # 369 W.Y. 02673 DIO TING RICT R-25 IND.) (STREET) BETWEEN AND (CROSS STREETI (CROSS STREETI LOT SUBDIVISION 14/1 LOTl82 RAPK-9 SIZE--41 BUILDING IS TO BE FT. WIDE BY t FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE 5 BUSE GROUP ' •-4 BASEMENT WALLS OR FOUNDATION ITYPE) REMARKS: Florida room o wood deck/extending north east section 7' 6"AREA OR VOLUME ESTIMATEDJOST $�y�_FEEMIT $ ,L09_DO ICU61C/SQUARE FEET( OWNER Lawrence O'Connor ADDRESS4"118 JLdmiral Lane, Key West Fla. 33040 BUILDING DEPBY L . INSPECTION RECORD. a DATE - NOTE PROGRESS - CORRECTIONS AND REMARKS INSPECTOR 31 vi o �o /Av -- . o �P cal ONE & TWO FAMILY ONLY - BUILDING PERMIT . APPLICATION TO CONSTRUCT, REPAIR, RENOVATEtRiDEMOUSH 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) 398-2365 Office Use Only `' / Permit No :0—LydDate 7'a a Permit Fee — DepositRec'd. $Pj Dateik:!"Ob k Net Due Planning Board Information plan Type Endorsement Date Recording Date plan No. Assessors Department Information: map Map 01 / / Map ; -L l Old New 1.4 Property Dimensions: LotArea (si),c/3 Frontage(ft) Lot Coverage Other " This Section for Office Use Only Building Permit Number: I Date Issued: Signature: �/ .7 wilding Offi ' Date Certificate of Occupancy 1/ is is not required Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: --�� •+ 1<RCAT%-S/AA1J) /CoaD 1.2 Zoning Information: g oning District Proposed Use 1.3 Building Setbacks (it) Front Yard Side Yards Rear Yard Required Provided Requ' ed Provided Required Provided o 4- — ,S /S woXI arl-1i 1.4 Water Supply (M.G.L. e. 40. S 54) Public Private 1.5 Flo d Zone Information: Comments: Zone: a-t- & L BFE: Section 2 - Property Ownership/Authorized Agent 2.10 /yy'nor of Record: �7 / L-A[✓,?ENCC J/ gdm. . / t• Sri /C,� Na Mailing Mailing Address �30vD OrlisKrxl� O �xr.L- ,So 77,t = � 7c ., Signature Telephone 2.2 Authorized Agent: - Na (pr' ra (pr't) u�� �1067 Mailing Address 'J 7 -P747 � say nature TelephgAe Section 3 - Construction Services 3.1 Licensed Construction Supervisor: Not Applicable ❑ �a z8 200� C Licerum r _ A!7/ �G�Jr -O' O G r% Expiration Date a0a ligriature Telephone 3.2 Registered Home Improvement Contractor: Company Name r -2&1L Not Applicable ❑ License Number A es gnature Expiration Dat rj 9-15-99 tof2 OVER Section 4 - Workers' Compensation insurance Affidavit (M.G.L. c. 152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached Yes ......... No .......... Section 5 - Description of Proposed Work (check all applicable) New Construction I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations Rf I Addition ❑ Accessory Bldg. ❑ Type Demolition Other Speci : _ Brief Description of Proposed Work: D ~ S1oc7' ` '` -4 11 Costs Section 6 - Estimated Construction Item Estimated Cost (Dollars) to be completed by permit applicant Check Below ' ❑ Conservation -Commission Fling (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) 1. Building 2. Electrical S °O 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & additions) Section 7a - Owner Authorization - Owner's Agent or Contractor Applies To be Completed When for Building Permit ), O 6-i. .` hereby authorize �7rrhAod ':? 1 AR1JF4V , as owner of the subject property to act on my behalf, in all matters relative to work authorized by this building permit application. 6(L,2'4e D �_e�n +ot� ,n,/Jyed Signature of Owner Date Section 7b - Owner/Authorized Agent Declaration I, enVA 2 D ,f Z /PA TIZ . , 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. Ze171AZD %�- 6A72Ne-A0 �l yrZ—. Print name Sig ture of Owner gent T—� Date 9-15.99 2 of 2 0it°f-"R4c TOWN OF YARMOUTH r���.},�sy BUILDING DEPARTMENT 93-� BUILDING PERMIT APPLICATION SIGN OFF Applicant: _ / c W'1 xD ;) 6427100-411 J /7 -Building Permit No.: Address C Tel. No.: 7��-475�7 Date Filed: 00 Bldg. Site Location. ( Map No.: 9 Lot No.: The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION CONWISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc. HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements for Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ---------------------------------------- The following Departments must sign off, in the respective order, prior to building inspector issuing the required , building permit. REVIEWED BY: V`WATER DEPARTMENT: �-- �� DATE: 10 -� ' a-� N/A: DEPARTMENT: DATE: N/A: .CONSERVATION: CONSERVATION: DATE: N/A: lh. HEALTH DEPARTMENT: DATE: I C oa N/A; 5. WIRING INSPECTOR: _ 6. PLUMBING INSPECTOR 7. FIRE DEPARTMENT: — PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. ,.. / 1 _ DATE: N/A: DATE: N/A: DATE: N/A. - klw_a Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ICI ICI COPY Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information From: YARMOUTH Conservation Commission To: Applicant Property Owner (if different from applicant): Lawrence O'Connor Name 369 Great Island Road Mailing Address West Yarmouth MA 02673 City/Town State Zip Code 1. Title and Date of Final Plans and Other Documents: Name Mailing Address City/Town State Zip Code Proposed construction for Lawrence O'Connor REV 2/2/01 Title Final Date (or Revised Date if applicable) 2. Date Request Filed: 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 (if applicable): To enclose an existing deck Project Location: 369 Great Island Road West Yarmouth Street Address Clty/Town 14 1 Assessors Map/Plat Number Parcel/Lot Number WPA Forth 2 Page t of 5 Rev n7m Massachusetts Department of Environmental Protection Bureau of Resource Protection- Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) has been received from the issuing authority (i.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plan(s) Is an area subject to protection under the Act. Removing, filling, dredging, or aftering 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 no - 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 after that area. Therefore, said work requires the filing of a Notice of Intent. ❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will alter an Area subject to protection under the Act. Therefore, said work requires the filing of a Notice of Intent. ❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Name Ordinance or Bylaw CRation WPA Form 2 Pape 2 of 5 R. fl7IM Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but iLot subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s), which includes all or part of the work described in the Request, the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Altematives 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 alter that area. Therefore, said work does not require the riling of a Notice of Intent. ® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Act. Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (if any). Roof runoff shall be handled by drywells or drip trenches. ❑ 4. The work described in the Request is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. WPA Fa 2 Page 3 d 5 R. mmn 0"CONNOR Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 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 applicable statuatory/regulatory provisions) ❑ 6. The area and/or work described in the Request is not subject to review and approval by: Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. Name C. Authorization This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on Date Ordinance or Bylaw Citation ® by certified mail, return receipt requested on 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 Appendix A) and the property owner (if different from the applicant). 2/01/0t Date wPA form 2 Page 4 d 5 Rn n7m Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Appeals The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work Is to be done, or any ten residents of the city or town in which such land Is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office (see Appendix A) to issue a Superseding Determination of Applicability. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see Appendix E: Request for Departmental Action Fee Transmittal Form) as provided In 310 CMR 10.03(1) within ten business days from the date of Issuance of this Determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. WPA fom 2 Pepe 5015 R. WIM _J?L-AR. �IwwT�oN _ �...... ... i ,L;bf n�13 5/yll y.e1ro^- S6: Vs% "A Y+al C2 T r'Y7 rwr' �rS T• 11!^I y�rin'4S r'L-d _tbodd.g annon6aee1 Ni ' - � 3rzr� �Is•r3—�! • N /ri 1 I 1 1 1 1 ' 1 1 � , 1 � 1 8 ` ..ii YaHE A510 9 Cnoi� blr llclrJ +r• as c �.17':. - IN � lT r- r 5 �.• r .. 'J � I rM..r4L 1 r[ /'� \ \'��� TYl.1/+1 WAIF 1 14'. .+�.+. 4X �.•.4 N.'; i� 4! W.ry +Y i� ♦ � �.r N -s��`(iy(�J v!, 3}\•I+�ri. NA`?j'°'ji',r °cfYht `► 71 'Tilt.tlp'i.►�all w+�b~st�{:,1,3t•+,k � +A �' 1P• xy�j„',;. �K.e r4 fit. � � Mii'� -4�' � �1 �+'+�.:lr�Jj,.�n^�, •!���r_Y� . ! 1 w i . n.1_: 'en..r�� .+�+e�e+vzr+e'+.'A^y".' o-y' � r�'.,., •�' a r �i 'air. t f.,q.k,fi '1?r.t. CrSwy�;n7ratntr 15'�j�+ArdY,+rNwmi... m>-i-1-^q:'Svt i+ti 1. vie;- �.. iY"Iiw r�•s•f.b h{.lv •�� ti m�n1 91?e -Commai�� 0/q--, Board of Building Regulations - One Ashburton Place, m 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 04/04/1957 Number: CS 009714 Expires: 04/04/2002 Restricted To: 00 RICHARD P GARNEAU JR 251 WOODSIDE RD W BARNSTABLE, MA 02668 4. Tr. no: 21613 Keep top for receipt and change of address notlncation. B and o Building ReguIa ones/ �d Stan ar s One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 100034 Type: DBA Expiration: 6/8M2 RICHARD P. GARNEAU JR. G.C. & Remod Richard Gameau Jr. 251 Woodside Rd W. Barnstable, MA 02668 Update Address and return card. Mark reason for change ❑ Address C Renewal Employment ElLest Card t i R TOWN OF YARMOUTH 0r '� 3 .c �r.....S,�S" BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. Job Location: s `t/ Number Street Nillagc Owner of Property �AwR r.✓e D'Cd�,�? _ .✓o.nc ya?�- ao6T Construction Supervisor: 41rtfAlz! Name Address: Licensed Designee: . ��i✓J P - (If other than Supervisor) Name License No. 2.15 Responsibility of each license holder: Phone No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes �d No ❑ If you have checked M, please indicate the type coverage by checking the appropriate box. A liability insurance policy 0 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Cha ter 1 2 ofje Mass.�peneral Laws, and that my signature on this permit application waives this requirement. 7 // r? JG� . . J Check one: of Owndr or Owner ❑ Agent Q Signature: I ifIa4ZA Ir_ 52hcitdi Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: 1%-c it tic -%sew Est. Cost Address of Work Owner Name: At )ReA1C (? Q%CQAeyQ R Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Z01c2qL00 , If A n 03 'Date Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name The Commonwealth of Massachusetts Department of Industrial accidents Omce elloyestlpstliis 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit I am a hord owner performing allwork myself. [� I am a sole proprietor a�J ha%e no one %corking in any capacity 0 lam an employer pro%iding workers' compensation for my employees working on this job. comfy name: address: insurance co. policy 0 O 1 am a sole proprietor. general contractor, or homeowner (circle one) and have hired the contractors listed belowwho hace the folloscin2 workers' compensation polices: address: city: phone N: Failure Insecure coverage as required under Section 25A of MGL 152 caa lead to the imposition of erimlaal penalties of a line up to SI,500.00 and/or one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fiat of SI00.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification. 1 do hereby cerrif)- under the pains and penalties of perjury that the information provided above is true and correct Signature / , ru1�s�i /i1 Date co Print name P 6AZA)rAJ -1 ,2 _ Phone N G�OGl olncial use only do not write in this area to be completed by city or town official city or town: YnxrlooTll _ permit icense N n8uildlog Department pucensing Hoard check if immediate response is required 261 OSclectmen's OMcc contact person: C3Healtb Department phone N: _ (508) 398-2231 est. _ nother Imued 3,95 ►JA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An emphnver 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 o%%tier of a dwelling house having not more than three apartments and who resides therein, or the occupant of the daelling house of another «ho employs persons to do maintenance , construction or repair work on such dwelling house or un the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. NIGL chapter I -;' section also states that every state or local licensing agency shall withhold the issuance or renewal of a license or, permit to operate a business or to construct buildings in the commonwealth for any :applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commom%ealth 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 supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts, Department of Industrial Accidents fftice of 111res9119823 600 Washington Street Boston, Ma. 02111 fax 9: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 TOWN OF YARMOUTH C Ou, H PLEASE PRINT: DATE: JOB LOCATION: "HOMEOWNER" BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 260 HOMEOWNER LICENSE EXEMPTION NAME STREET ADDRESS SECTION OF TOWN NAME HOMEPHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as su,pmjv or. (State Building Code Section 108.3.5.1) Definition of Homeowner: Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and / or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner" shall submit to the building official, on a form acceptable to the building official, that he / she shall be responsible for all such work performed under the building permit. (Section 108.3.5.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes Pf No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Z Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. 1Check one- re of Owner or Owner's ent Owner ❑ Agent W/� h:homeownfli==p TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS0266411451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398.2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 364 6z-1P,tr1's AAI D W. 1,y4Z7Mv077, Work Address / is to be disposed of at the following location: '^Z Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. �.y ApplicantSignature of Permit No. PLOT PLAN AbuttorIs Name Lot # If this is a corner lot, write in name of street. 1 FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) ED Well jg I I rear) I REAR YARD Dti � ' N c SIDE YARD G SIDE YARD — FT_ HOUSE R SETBACK Ap (lot..1.6.1.....ft. frontage) (NAME OF STREET) n V? V Supplied ls�A77DTI17. AS %rz C, zT, f �o'T MAN Abuttor I s Name Lot # If this is corner lo- write in name of other street. MARK NORTH POINT SUBMITTAL REQUIREMENTS / CHECK LIST FOR BUILDING PERMITS New Structures 1. Application signed by the owner and owner's authorized representative / construction supervisor. Application shall include: Construction Supervisor's License, Worker's Comp. Affidavit / Certificates, Home Improvement Affidavit (all applications except new homes). 2. Four proposed site plans, stamped by a Mass. Registered Professional Land Surveyor, showing all boundaries, proposed setbacks, existing & proposed grades / contours, proposed location of structure(s), parking, curb cuts, drainage, impervious cover calculations (when applicable), flood zone and Title V design and any other zoning related details deemed necessary. 3. Three sets of complete construction plans, including a complete structural cross section, floor plans, use of rooms, dimensions, window & door schedule, HVAC details — electrical, plumbing & mechanical plans are also required for commercial & multi -family (3 units or more) structures. 4. Flood zone applicability — Compliance with Section 3107 of the State Building Code — Elevation orJlood-proofing certificates (whichever is applicable), shall be submitted prior to the issuance of a certificate of occupancy. 5. Plans shall be reviewed by the following departments: Health, Engineering, Fire & Conservation (when applicable). The Building Department will forward. 6. Old Kings Highway & Historical Commission (when applicable). 7. Mass. DPW approval for State Highway curb cut and access ways. 8. Construction control affidavits for all projects to be constructed or altered under the provisions of Section 116 of the State Building Code. Buildings containing 35,000 cubic feet or more. One & two family structures are exempt; except certified designs may be required for unusual structural circumstances. Section 3107 of the Building Code requires certified plans for new and substantially improved structures in flood zones. Additions 1. Same as above, except the blank generic `Plot Plan' available from the Building Department may be used for one & two family structures when setbacks are not marginal. 2. Flood zone applicability— When the value of improvements equals or exceeds 500/o of the structure value (substantial improvements). Alterations 1. Same as above, except existing & proposed conditions shall also be shown on the plans. NO WORK 1S TO COMMENCE UNTIL THE BUILDING PERMIT HAS BEEN ISSUED. Filing a building permit application does not imply approval and should not be construed as permission to begin work. I 1 I 1 1 LOTe1 3 I i 1 K I I►r. c t-26EITTa r / tE u LUT$Z 19,40e # t c.*,. y RA%IMAT - C45oos= $EIaJ r EACHIN(% MMW L� AREA, b S' 1 1-SjiA4— — 1 ,EDGE O� �• - 2, _Almal fR.. , tJ,DN+•7LR.1 V G --� i%Isnr+q - I 1 7ANK O t3X1 ]TIN4 I I Gxlijw DOCK G•0 pPR 80 Wb. FRt%. j �WGLLIN6 j > I �+S I li I P�+TIO Lp.vl nla 1 L t ; Block. SURfwcE� C. 90_1sa._t APPROVED: .BOARD OF HEALTH DATE AGENT NOrC .. pp ordJiD A00/T/on/ rL>/JT/ Cie AeA91Y.TRE.VCH AYd�rr 1 ,,, titA / G SH TL�area tg OF yo t 'CFCISTit lip 'a Eo tAxoti FAOM 2/22J84 SITC TE-1Pbv-APY PE=P ' IT PLn/v ar C. e.tN�ar, MAS5 L.S. 195Z-7Z IS�rvP.4 t /: 8g, q,i/I D+ /o.r+rYTI Ilrov .�, i i WALK 1'L•t xa7A4 NI u4 4. WALL- -� 7. } PROPOSED (;ARAGEeDECt FOR PRMECT LOCATION 347 ZZ). v\/E.5 T' VI) L/1'IC9 UTN MfTZ CRAIG R. SHORT PROFESSIONAL ENGINEER 508- P.O. BOX 1044 1398-8311 SOUTH DENNI% MASS 02660 SCALE 1 = 20 DATE / 0�22� i'J roe No. xEVLSLn SHEET / OF / RMSED RE F EZE UC.E • Lc-FL.144-Z 6' ELEVAT101J5 -tA\tE-b OIJ 1-1S.AM SE.A LP.VEL. FILE" I7--4S8 _ a r TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO F .... . PERMIT ISSUE DATE :- 1tj? 0¢ .. . PROPOSED USE APPLICANT 'Brian Rodoalpt. ' . ' ' ' ' ' ' ' ' ' ' ' " ' ' " : .............................. JOB WEATHER CARD PERMITTO :ksoJ rmittransfef, AT (LOCATION) 100369GREAT ISLAND RD ZONING DISTRICT R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1014.1 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE permit transfer - new windows, doors, roofing, siding, interior changes, new kitchen, new floori ical REMARKS service, bathroom renovations, new eAerior decks as per plans submitted 7/26M - Note: Pr encroaches Into front setback and Is to be deleted from project Refer to FB-07.224 AREA (SO FT) EST COST ($ $240,000.00 PERMIT FEE ($) $50.00 OWNER IMartin Reilly I BUILDING DEPT BY ADDRESS 122 Main Street Hyannis MA 102601 INSPECTION RECORD CONTRACTOR LICENSE 080558 FRodoalph, Brian 7 Field Island Point - Sandwich MA 02563 5085423222 PHONE 15087714536 FIELD COPY Date Note Progress - Corrections and Remark Inspector /o TO eN OF YARM0UTH- Building Department _. 8 U I L D I N GV . _ • (508) 398.2231 ext.261 PERMIT NO FB-W-tea. PERMIT •• ISSUE DATE ;...... Q06 . ; PROPOSED USE . , """"""""' . . JOB WEATHER CARD APPLICANT Walter Brennan Jr. PERMIT TO Alterations AT (LOCATION) IOM69GREAT ISLAND RD ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK LOT SIZE BUILDING IS TO BE: CONST TYPE] 5-B I USE GROUP] R-4 new windows, doors, roofing, siding, interior changes, new kitchen, new flooring, electrical service, REMARKS bathroom renovations, new exterior decks as per plans submitted 07/26/06 - Note: Proposed Portico encroaches Into front set back and Is to be deleted from project. AREA (SO FT) EST COST ($ $431,000.00 PERMIT FEE ($) $485.00 OWNER Martin Reilly BUILDING DEPT BY ADDRESS 122 Main Street Hyannis MA 102601 CONTRACTOR LICENSE 004389 Brennan, Walter Jr 267 Magnet Way Brewster MA 02631 5084007388 PHONE 18178729933 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remark Inspector of , TOWN OF YARMOUTH Building Department BUILDING c (50p) 398-2231 ext.261 PERMIT NO 4B-06-1505 ......... �k ISSUE DATE 6[19/2QQ¢ . ; PROPOSED USE PERMIT Brennan " APPLICANT 1N"..... ""' .. JOB WEATHER CARD -----.------ PERMIT TO Demolish AT (LOCATION) 100369GREAT ISLAND RD ZONING DISTRICT R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1014.1 BUILDING IS TO BE: CONST TYPEF9--Bj USE LOT SIZE selective interior demolition - Approval In Part as Per 780 CMR Sect 111.13 REMARKS AREA (SO FT) EST COST ($ $75,000.00 PERMIT FEE ($) $50.00 OWNER IMarth Reilly BUILDING DEPT BY ADDRESS 122 Main Street Hyannis 102601 INSPECTION RECORD R-4 CONTRACTOR LICENSE 004389 Brennan, WatlerJr 80 MatLakese Road Unit 2 West Yarmouth MA 02673 5084007388 PHONE 16178729M FIELD COPY Date ( Note Progress - Corrections and Remark I Inspector `0 DOW L Braman, PE , 189 Harbor Point Road Cunwrrquid, MA 02637-0361 Pbone (308) 362-6016 February 22, 2007 Brian Rodoalph BriCo Associates Inc. 178 Thornton Drive, Hyannis, MA 02601 Project: 4407 369 Great Island Road, West Yarmouth, MA For: BriCo Associates On this date,at your request and in your presence) made a site visit to the above residence, which has been extensively renovated and remodeled. I made a visual, non-invasive evaluation of the structural integrity of this residence. The construction has been well performed and I believe is structurally sound. Particular condideration and attention was given to the effects of wind load on the structure as well as vertical loads being carried to the ground level. The joining of the new and old has been well performed. i� .�'`�a Daniel E. Bram DANIEL E. �r�G • HAMAN /A� o ST(� ��fAL T". -07 1-9 oF'YgRONE & TWO FAMILY ONLY - BUILDING PERMIT 3? APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING p y Town of Yarmouth Building Department N MNiKMt , 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 ce Use On�ly tanning Board Information Assessors Department Information: Permit No. "'7 bate !o 469P"an Ld Endorsement Date Permit Fee $jWD Recording Date New Deposit Rec'd. � Dat No 1.4 Property Dimensions: Net Due $ / other Lot Area (sf) Frontage (ft) Lot coverage This Section for Office Use Only Building Permit Number. Date Issued: - Signature: o Certificate of Occupancy - .. Is is not required Building vial : ate Section 1 - Site Informat' Use Group: R-4 Type: 5-B 1.1 Property Address: �loA (3-►«f— --,�4.�10 12 Zoning Information: ROZ-6- Zoning District Proposed Use %—/A ( . YV,4- c7 d 4 73 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Re uired Provided Required Provided Required I � Provided Wl IS � lip 17)9 1.4 Water Supply (Y.O.L. c. 40. S 541 Public Private 1.b Rood Zone IntonnaGon Comments - j . Zone: BFE: S�P .,. By Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: AU,4j '>. {C Name (print Signature 2 Z ILLQc �. st Mailing Address Telephone 2.2 A ortzkd Agent: Name I �8 S`��3ZZZ S re L Telephone Mailing Address uy-7i`�l [Q Fax 2- Section 3 =Construction Services 3.1 License<d Construction Supervisor. -73r%L4-+` aaoALAfI Not Applicable ❑ 1 % 1-e- • License Number �S V S S Address ^d g -23f ZZ Z Expiration Date —�3— Q Signs Telephone 31rYa, 000ALp.,{ 3.2 Registered Home Im rovement Contractor Company Name tit e6 A-sK.Ve't a 7-0-S Not Applicable ❑ Address -ram / �� VA� ^.�, 1 License Number 9 S 3 Expiration Date J .69/ ftilA . 02-60-i W P•-1cA7 -.-> // —.?-LI - CI Section 4 - Workers' Compensation Insurance Affidavit (M.G.L. c..152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... Section 5 - Description of Proposed Work (check all applicable) New Construction 0' 1 No. of Bedrooms 3 1 No. of Bathrooms Existing Bldg. ia' I Repair(s) ❑ I Alterations ET I Addition ❑ Accessory Bldg. El Type Demolitio Other Specify: Brief Descri tion of Proposed Work: v%a G PLC ti t MCI Z K �— ZZ Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) 1. Building /iT aaD 2. Electrical 'LO oaf 3. Plumbing / Gas 2�a- -D"IXD 4. Mechanical (HVAC) 010070 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) cax-fQ p 0 a 7. Total Square Ft. (new houses&additions) To be Completed When for Building Permit Section 7a - Owner Authorization - Owner's Agent or Contractor Applies I, Y11 r as owner of the subject property hereby authorize to act on my behalf, in II matters el , to work authorized by this building permit application. 2— O Signature Owner Date Section 7b - Owner/Authorized Agent Declaration I, , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. 3 6 T r /4 PA s of perjury. //\J�yj.(t Signed under th ains andcc penaltietOc.� , 'y� Y ate, Print name Ole Signa u of Ow eaAgent Da 9. 15.99 2 of 2 The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/orpnizationftdividual):17 c� r`ia A n o Address: % Ft-eld :ki[o-J ?0r.1"T' City/State/Zip: Sa C w� �: , A Phone M 4�J5? Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. aI am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. Li I am a sole proprietor orpartner- listed on the attached sheet : ship and have no employees working for me in any capacity. [No workers' comp. insurance 5. rcquircd.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance roquircd.] t These sub -contractors have workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c.152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. [RNew construction 7. MRemodeling 8. ❑ Demolition 9. ❑ Building addition I O.j3'Electrical repairs or additions 11.21 Plumbing repairs or additions 12,E Aoofrcpairs' 13.❑ Other 'Any applicant that checks box / 1 mat oalso till out the section below showing their workers' coagxaauion policy information 1 Homeowners who submit this affidavit b&catmg they are doing all work and then hire outside contractors must submmt a new affidavit indicating suck tContractors that check this box must attached an additional sheet showing the some of the cub -contractors and their workers' comp. policy information. I am an employer that Is providing workers' compensation Insurance for my employees. Below Is the policy and job site information. / / _, --r-, - I _ / ,.. _ . , -#, ` Insurance Company Policy # or Self -ins. Lic. M G KyJI6 RS%g'/ 23- ' Expiration Date: / d — / � — 04• Job Site Address: 3 6 R Q- �` � 14 City/Stamp: 11L,/ o a -;3 Attach a copy of the workers' compensation policy declaration page (showing the policy numbir 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 certo under pains pgd penalties of perjury that the Information provided above is true and correct Phone # �— Official use only. Do not write In this area, to be completed by city or town o,Q4ckL City or Town: Permtt/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cityfrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other 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 pro-odsting 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: 2r- noy 4-��1 Est. Cost c>7gd , OW Address of Work Owner Name: v-tty M7 Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: i)ate homer Name TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. Job Location: s 3 G q (:xv Number ro Owner of Property: a'r` 11 Construction Supervisor: Address: Licensed Designee: (If other than Supervisor) Name l-/ SS License No. License No. Phone 3222— 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 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes 0- No ❑ If you have checked M. please indicate the type coverage by checking the appropriate box. A liability 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 Owner ❑ Agent ❑ TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS026644451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 998-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 3 62 1 Q,0-t- Zed" AAA Work Address is to be disposed of at the following location: Wasy-lr �s 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. 9 oQ7--(n-6 Date TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 261 Fax 508-398-0836 BUILDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Scope of Proposed Work: Date: 1 ' `ai —6�0 ' � 2W _ "sr 44"t . Based on the scope of work described above, the applicant is required to obtain approvals/sign- offs from the following departments as checked -off below: Health Dept. — Town Hall Phone No. 508-398-2231 ext. 241 Conservation Comm.— Town Hall Phone No. 508-398-2231 en 288 Water Dept.— 99 Buck Island Rd. phone no. 508-771-7921 Old Kings Hwy. Mist Comm.— Town Hall phone no. 508-398-2231 en 292 Engineering Dept. —Town Hall phone no. 508-398-2231 ext. 250 Fire Dept.--Capt. Kelleher, 96 Old Main St. So. Yarm. Phone no. 508-398-2212 Other Appropriate plans and/or application shall be provided to each of the departments checked -off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for cooperation. .1 ■� . / ✓he �oornrnanu.asl� o�,.•l(.aau��.m.ldsS .�. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 080556 Birth date: 04/23/1958 Expires: 04123/2007 • Tr. no: 11017 " Restricted: 00' BRIAN W RODOALPH 7 FIELD ISLAND POINT G— / SO SANDWICH. MA 02563 "^^ Commissioner ✓�ie �mrnanu�� p�,�iasHrc�rufe+lG Board of Building Regulallons and Standards HOME IMPROVEMENT CO\TrE.CTOR -i Registration: 144983 Explrati or,: 11124 r+006 Type: Individual BRIAN RODOALPH r BRIAN RODOALPH y 7 FIELD ISLAND POINT t+ �,ANDWICH. MA 02563 - :S 9/26/06 3:44:26 PM 4170 M 03/03 AC-QB . CERTIFICATE OF LIABILITY INSURANCET -GATE 9 26 2M 006' PRODUCER (506)540-2400 FAx (508)289-6111 Murray L MacDonald Insurance Services 406 Jones Road Talmouth MA 02540 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY UPON THE CERTIFICATE HOLDER.NTH SONFCERT FICATES NORIGHTS DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC0 INSURED SRI-MAR REALTY TRUST 7 rILLD ISLAND POINT SOUTH SANDWICH MA 02563 INSUPERA:Charter Oak rise 25615 INSURER B Travelers Insurance INSURER c. Travelers Assigned Risk INSURER D' INSUPERE THE POLICIES OF INSURANCE LUSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VIATH 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR R WORDTYPE OF INSURANCE POLICY NUMBER DAIC`/ EMIDD YIYVE TQ PGACF EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE 1 1, 000, DOO PREMISES Ee o=ffome 1 300,000 A COMMERCIAL GENERAL LIABILITY CLAMSMAOE OCCUR 1680DISM750 5/30/2006 5/30/2007 MEDEXP An one anon 1 5,000 PERSONAL S ADV INJURY 1 1,000,000 GENERAL AGGREGATE F 2,000,000 LRRIMpI. APPLIESPER GENLAGGREGATEppCT PRODUCTS-COMP,DPAGG F 2,000,000 X ,E POLICY LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE I MR (ES eayden0 $ BODILY INJURY (Per Oumn) 1 100, 000 B ALLOVMEOALUTOS X SCHEDULEDAJTOS ADG)L672L947825DO6 5/30/2006 5/30/2007 BODILY N.URY (PreotlWnO 1 300,000 X HIRED AUTOS X NON -GINNED AUTOS PROPERTYDAMAGE (Per sotldelt) 1 500,000 GARAGE LIABILITY AUTO ONLY • EAACCIDENT i OTHER THAN ACC If0 ANYAUTO 1 AUTO ONLY: AGG EYCESMMORELLALIA&LIT' EACH OCCURRENCE F AGGREGATE 1 OCCUR CWMSMADE 1 1 DEDUCTIBLE 1 RETENTION 1 C VYORNERS COMPENSATION AND 70 MI RM- EMPLOYERS' LABILITY ANY PROPR ETORNARTNERIEXECUTIVE OFFICERAfEMBER EXCLUDED? 5KDB68512156 10/18/2005 10/18/2006 EL. fJ�CN ACCDENi i SOD, OOO EL DISEASE• EA EMPLOYEE F 100,000 EL OGFAIvF-ROL ICY LIMR S 50D,000 If Ns, desmbe undr SPECIAL PROVISIONS Beim OTHER DESCRIPTION OF OPERATIOFSILOCATIONSNEHICLELEXCLUSIONB ADOEO SY EKUMEYEWSPLOAL PROVISIONS Project Located at 369 Great Island Road West Yarmouth 1% 02673 &aural I AT1nu SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ToMn of Yarmouth EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL Building Inspector 10 DAYS VMTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Route 28 South Yarmouth, MA 02673 FAILURE TO 009004AM IMPOSE NO OBLIGATION OR LUASLRY OF ANY MINO WON THE INSURE RS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE S Harrington/SMH ACORD 25 (2001108) INS0251=6pr AMS VMP Money Soktiom. Inc (600)127-0545 7683 vnwnuwnrORAHVR TOAB Pogo I of 2 09/26/2806 16:47 5085635587 MLRMACINSLRANCE PAGE 02/02 DAYS immo/YYYYI ACOW. CERTIFICATE OF LIABILITY INSURANCE 9 6 2006 PROOR (508)540-240D FAX tS08)289-4111 ONLYCANDF IcATE ONFERS�NOE RIGHTS MA RNFOR THE ( UCECERTIFICATE Murray N: MacDonald Insurance Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 406 Jonex Road ALTERTHECOVERAGE AFFORDED BY THE POLICIES BELOW. INSURED BRI-MAR REALTY TRUST 7 mLD ISLAND POINT Brian Rodoalph SOUTH SANDWICH CO ES INSURED NAMED ABOVE FOR THE DOLICV PERIOD INDICATED. NOTWITHSTANDING ANY THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE RESPECT TO VMCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH TO ALL THE TERMS. EXCUJSIONS AND CONDITIONS OF SUCH POLICIES, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. w L rn9OrINSURANCE POLCYNUMER pAiaTMwo Te MXAD LOFTS 1,000,000 EACH OCit { 06MERAL IJABIUTY AO oR D f 300,000 OWARGALOCNERALLM4lRY 5/30/2006 5/30/2007 RFLnS n MEDCKP A " ne s 5,000 A CLAMMADE OCCUR 11/0015OW750 1,000,000 PERSOHALE } RAL AGGREGATF s 2,000,000 IOP AC4 S 2,000,000 Con ACOAEOATG LIMIT AFPLIVI PER, X POLICY AUTOMOBILE LIABILITY COMEwEDSINCWLMIT f (EA Eaodw) 8 ANY AUTO ALLOWNEDAUT03 AlJGI{172x9S7eiIAD01 b/30/2006 S/30/2007 BODILY INJURY 3 100,000 R' Peron) X SCMEDULLO AUTOS X WAGE)ALTros BOMYINJIRY (Pw AaloAU f 300,000 X NowoMMEOAuroE PROPERTY DAMAOE } 500,000 IoIK ocElaAnl AUTO ONLY -GA ACCIDENT f OMAGE4ANUTY OTHER THAN A AUTO ONLY: S ANYAUTO AO { VCESSNMSRSLLAMABOXY OCCURRENCEEACH f 6GOREGAT9 { OCCUR CLAMS MADE S DEDUCTIBLE } "reNrION Sy T� C WORRERSCOMPENSATION ANDY EMPLOYERS' LIABILITY G LEACH ACCIDENT s 100,000 ANY rAOPRIEYO"ART9A%XrCUTMG OPFIcrREM MDERe=U0E07 610JeSISX/156 10/18/2005 10/10/2006 E.LDI GASE-RAF"M 100 000 { I Ek. 0j$rA3G-POLICY WIT s 500,000 S Tn. ducrU lnYor PE IA rnOVls� s bw OTHER pES"pTON orO►EI{ATIONEIIOCATIONLVEWCLEW"fAUSWNS ADDED EY ENDORMEMENTIS►ECU.L PROVOIONS Proleet Located at 362 great Saland load Neat zatuouth NI► 02513 Hoses By The Sea Martin Riley 22 Main Strout Hyannis, MA 02601 iHouw ANY oc THE ABOYI VCSCMBGO POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TNEREOP, THE ENSUING WSUREII MALL ENDEAVOR TO MAL 10 DAn WOVITEN NOTCB TO THE CERTIFICATE {IDLDO MAMED TO M LEFT, BUT ;AEJJRE TO 00 SO SMALL WPOSE NO OBUGATION OR LMBILRT or ANY NMID UPON THE ITNORIGED RE►REKNTATNE w 'r�+-tr4 �` I Harrington/SHHf� O ACORD CORPORATION 1988 PAS02310 o" AMS vAe-lwmiP�wnonA, nc lwrvlx�va+a JUL. 6.2006_ 2:27PM____._ASSOCIATED INSURANCE NO 2529,R,P. CERTIFICATE OF INSURANCE 7F i AC A A OF llVPLIUgAaaONy+ Y PRODUCER Minuteman Insurance Agency 76 Blanchard Road Burlington, MA 01803 INSURED Genesis Consolidated Services Inc 76 Blanchard Rd, it 2 Burlington, MA 01803 COMPANIES AFFORDING COVERAGE A A.I.M. Mutual Insurance CO VERAGES M-iTii RFSPECTTO WHICH THLS THIS LS TO CERTIFY THAT TitE POtSCt6S OF nis T LISTED BELOW HAVE BEEN DVDICATED. N07 WtTHsrANDINd ANY REIi•TEa1i OR CONDITION OF ANY CONTAACr OR OTtnER DOCULO N r .RT BXCLU NS AND CONDIr101uOR CN FOLICISS LDdirS SHOWN MAY HAINSURANCE VIVRBBEEN REDUCED BYy THE POUCKES EPAID ECLAIMS � � ALL Ti38 TERAfs, TYM OF INSIRIANCC MUCTNI UES. DA OUVMNY) DA,CY L,p/IIS TR(MMMMY) ENEPAI.AGGREGATE S jmmLALLIABDITY OOUCTS•COMPIO►AGG. S MMERCIAL 02 MRAL LIABILITY PUSONAL A ADV. INJURY = S MADC3= CH O=RRRNCZ f WNsR'R A CONTRACTOR'S PROT. RE DAMAGR (Ap on Tw) S ED• EXPENSE(Amy ON Pw" S INRO SINGLE f UTOMOBILE LIARIISTY R NY AUTO Da.Y INURY LLOWNEPAUTO$ fpa" f ED AUTOS DOILY INJURY f AUTOS Jam) 0N4wNED AUTOS ARAGE LUEILRY' PERTY pAMAGR OCCURRENCE, S Ims LL431= - GREGATE f RELLA FORM ER TWIN UMBRELLA FORM X 'C S(A U• X OTH- . WORKERS COMPENSATION AND OIrolnoo'I S ERS'LLA21UTY 7015863012006 EMPLOYOIro112006 f u A THEPROPRIRTOW X 1NCL E pU p_E MP P f I O00 000 PARTNE)XVOCECITOVE . OFFICERS ARE. pz•,S(�1FIION OF OPPIA110Ni4.00AYIONSM1'6lOCLSS�'RIrmo COVERAGE IS RESTRICTED TO EMPLOYoy EES CHASED T0: BRENNICK BUILDING SYSTEMS, LL . r36 ISLAND RD: INTERIOR WORK, 5 WEEKS. CANCEL LA[ION OLDER SHOULD ANY OF THE ABOVE DESCRIBED PORGIES BE CANCBI IED BEFORE THE EXPIRATION DATE THEREOF, no ISSUVjG COMPANY wu.L ENDEAVOR TO ARMOUI'H MAIL 15 DAYSWRrITENNOT[CETOTHECERTIRCATBHOLDERNAMEDToTHE ,DIIVG DEFT, Lm, Bu, Bur AAB.URE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATIONOR 1]AB=Y OP ANY RIIdD UPON THE COMPANY, . rrS AGENTS OR 28 REPRESENTATIVES.TH, MA 02664 I 07/06/06 15:17 FAX 781 860 9582 GENESIS 16001/001 N0. 2528==P. 2/f� "JUL, 6.2006 2:25PM,-,ASSOCIATED INSURANCE L%bumw•,AQA.,rr •• CEATIOCATE OF iNsupANCE M1m=manb=a°� ABLY COWAWS A'O�IN(; COVERA� 76 Blanchard" ' Balingmu. MA 01803 uoxm 0.=is Consolidated Se YIOCs Inc 16 Blanoimd Rd.112 Burl USM. MA 01903 A A.I.M. Mutual Insara= Co TQIZ.i AND t.Sk`7[X►)�� w' _ _ mpL=hm9= oAa Ar1 111fEOVIIIRZ'�AIILY LUAaam W YAMa Mim's a OOMAACM, Pear. ;OnIIB ilAlanY ANY AUTO owt= Was UMD AUFQ5 m AU'ro! AUros I1ARWV Sm LuM fT Pam F=tHANUM➢ rLiA7lDkM wrvoalVp AND 701586301:t006 011011J»OG O11U1I= -- to= CGOOisOMAAM amw,O)UILY RMY A rW TVMGwp rwo faff ! )SW= ! UMY 1 f promo, ):l.Y - uultY ! p1iMIQ UWAS ALA ,Lo�►�o I�MPt o 1.�Asrsv zo ex>ax1nCK BU=ING SYsrr1I8. LI.C. )VERAoi+IsRsSiRI HiTRIoRWom5WVMS- B: 369 ORJ!Ar ISLAND Wort caNCw� DnscANcw��'� y TltiG7>+1i0iDSR OR TO WaA=W D �p im WU� � AWM70Tag MAu•�DnYS WjA r W NGT=TO Tl� Cl�Ig�CA TOWN OF YARMOU'rH svad Now MA L Da*� ri0 oauar►=toN � ig'T. DIU pjk, To �' �, (:OlL4ANY, IC: Nis AWN. B�,DRIG ])Wr, UAeurnr Of ANY � OPart U46;Lo= 28 �pAgBHNTArnss. Avtso4usv gttA.ilVC S. YARMOUTHR 1k OU64 ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 Office Use Only Planning Board Information Permit No. 4attW Plan Type Endorsement Date Permit Fee $ Recording Date Deposit Rec'd. $�o Date No.- o Net Due oy , the Assessors Department Information: Map Lot New 1.4 Property Dimensions: Lot Area (sf) Frontage (It) Lot coverage is Section for Office Use Only Building Permif WjfnW, I Date Issued: Wig'-� Signature: Building Official Date Certificate of Occupancy is not required Section 1 - Site Information I Use Group: R-4 Type: 5- 1.1 Property Address: 34o9 6214A7- ^f2r7 1.2 Zoning Information: Zoning District Proposed Use Gil. V4tfl-iftl" "/ /-1-4 1.3 Building Setbacks fit) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.O.L. c. 40. S 54) Public Private 1.5 Rood Zone Information: Comments: Zone: BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Reco /y,4tZT1iN,wf-, Gl y 2 - H,4,;O s 77 I -I VAf A-W S H4 Name (print) Mailing Address - s72- 9933 Signature Telephone 2.2 Authorized Agent: 41A1-71,2 C? P.�/.�-W_ .J ✓51. 26 k-- - Name (print) Mailing Address f06- q,00_ 0B- 7s-6333 Signature Telephone I R Section 3 - CondIfuction Services 3.1 Licensed Construction Supervisor. JUL 2 �(]6 IdWF Not Applicable El Z2&-7 a/ S T /z o 2- co 3 DD LDING D"cPT. Address O8-00- icense Number �� .3 9 Expiration Date W191Y.'r6. ature elephone 3.2 Registered Home Irri rovement Contractor. Company Name Ab447-e.-C 0. r3' /li!I✓'6)R 4) *e -267 tfi46dG i GdA-,4f %3,Q Ft�S rrrR 1y14 . 0'24, 3/ Not Applicable ❑ License Number 7-7 S Address SOP- f7%00 -73 8 4 _ Signature Telephone Expiration Date l% —/ — d:.o Ill 1 of 2 OVER Section 4 - Workers' Compensation Insurance Affidavit (M.G.L c. 152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached Yes ..?. o ... No .......... Section 5 - Description of Proposed Work (check all applicable) New Construction ❑ No. of Bedrooms No. of Bathrooms Existing Bldg. U Repair(s) ❑ I Alterations Addition ❑ AccessoryBldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: 67d Iy%4 e F j f AA10 114 A-7 — tUJ i x'J0 UJ S o0 12 S do 7-t/11 U AJ4s PS (-W ITO I fc H Y if%-P )t:2ee Al A-fPUJ 4e L f-c 77e i to L _C"di [ 1� 499A.1.0 L Tya ut F cJ �x ro S Section 6 - Estimated Construction Costs Estimated Cost (Dollars) to be Check Below Item completed by permit applicant SOO00 O ❑ Conservation -Commission Filing 0 (if applicable) ZS 2S F O 00 ❑ Old Kings Highway & Historical ado Commission approval A1310 000 (if applicable) 3 SO O To be Completed When 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & additions) Section 7a - Owner Authorization - Owner's Agent or Contractor Applies for Building Permit I, , as owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Section 7b - Owner/Authorized Agent Declaration I, lwwz (::�P, 1-2Rt %-#A;1v'J ,as Owner/Authorized Agent hereby declare that the statements and iriformation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury.---- .-. ofiff/4 L T Ci2 C?? �Rf,r�,eiP,J Print name Gz-� 7 zy—oG Signature of Owner/Agent Date 9.15-99 V 2 of 2 o TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRIM. Job Location: '?&!2 2 ?A 7- Number _Street Village Owner of Property: Construction Supervisor: AY-47M eE' /,�P.cJXJAA)YO 4,WV395- 549-yQo --73H£3 Name License No. Phone No. Address: z&7 HAro,J� 7 eA-),V `� �i2PuJ c7�� f-1.4._ 07-6-3/ Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licenseewho 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: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes 14 No ❑ If you have checked yo, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 0 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the � e ral laws, and that my signature on this permit application waives this requirement. F 1 _ . / ( /� Check one: Owner I] Agent Signature: Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MOL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: 'pf od t/A >i0,J Est. Cost L13 / 0O16) Address of Work 36 9 4:5�12 t T T 1A fv 0 yp > o ce 5-I-/ Owner Name: )-1,4/2 7"/ 4) e < y Date of Permit Application: 7 z `/— 0 L 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: yy CAS aoL/38S ��2�r/datJz7C/S3 Date Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Address: f30 NA7Z7 t%2S—1 :Ra u,J� 7- Z- City/State/Zip: .9�?H�uY'lti/ &;1, ez&73 Phone #: 08- yvo -7388 Are you an employer? Check the appropriate box: 1 I am a employer with 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- listed on the attached sheet = ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. (No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 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. \emodcling 8. emolition 9. Building addition 10. ectrical repairs or additions I LEI Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other eAny applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information: 1 Homeownera who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below Is the policy and job site information. Insurance Company Name: A, -L M• Policy # or Self -ins. Lic. #: %D/58630 /ZOO 6 Expiration Date: /2--3 l -0 Job Site Address: �lac7 �2rrAr �CtgaO i�0_ City/StatuZip: �.`7i9t?yl7thr/f/A071o73 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 cegify under (hepains and penalties of perjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: PermlVUcense # 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 M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings In the commonwealth for any applicant who has not produced acceptable evidence of compliance with the Insurance coverage required." Additionally, MGL chapter 152, §25C(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), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does 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 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 appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pemrit/license number which will be used as a reference number. In addition, an applicant that must submit multiple petmit/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. Anew 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. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 260 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOMEPHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code Section 108.3.5.1) Definition of Homeowner: Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended to be, a one or two fiunily attached or detached structure assessory to such use and / or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner" shall submit to the building official, on a form acceptable to the building official, that he / she shall be responsible for all such work performed under the building permit. (Section 108.3.5.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes ❑ No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ h%omeownrliccump BUILDING TOWN OF Y A R M O U T H ELEGTRICAL GAS 1146ROUTE28 SOUTHYARNIOUTH MASSACHUSETTS02664.4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398.2365 PLUDIBING 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 3�!q 45 1f-,4 i —1S Zo< AJjo /?0. !i. yi¢/liyatiY�/ Work Address is to be disposed of at the following location: 4,U lr-,O 4VASTer — -1>yA AST'C-R-S Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. &tbv,y Signs ur o Applicant i Permit No. -7 - Z 4/- o <.v Date Administrator Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: __127453 Expiration: 11l1I2006 Type: Individual WALTER C. BRENNAN, JR WALTER BRENNAN,JR,' •'_': 267 MAGNET WAY BREWSTER, MA 02631 07w c{�wms�anaralf/e V.,i uee&j BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 004389 Birthdate: 01/21/1951 Expires: 01/21/2008 Restricted: 00 WALTER C BRENNAN 267 MAGNET WAY BREWSTER, MA 02631 Tr. no: 13089 TOWN OF Y A R M O U T H CONSERVATION 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664 COWNUSSION Tel (508) 398-2231 — Fax (508) 398-0836 Town of"Yarmouth Conservation Commission - Building Permit Sign -off Application Cons. Comm. Received Date: 2—;?-!4 —4:13 Property Owner. gA2ri,J gi-I LG V Construction Address: 3(vq9/L9�AT / 2tq'0J1J 20- ze). Assessors Map and Parcel: MAPPARCEL / General Contractor:�:�3 /2r-A,1A> 1 c6r f:�3 u i, z-,o «1 G c-rYf i b'?J �D f-IiOT�'A6TFt� �, Company Name and Address:_`61 R/70a 73 Company Telephone: . A DD - 73 Oe Project Description: za ic"Oe 1W,9 J 170.c) — .C) i /L/ CL'i .t/✓� a u> s . _ C'i!0 I X) 6, �D Fi lJ(� 7- %J f [ %r�•✓L Contractor Plan Submitted: Tid, i2f!.yo✓A t id'V-S A�2 /�iQ2Ti,cJ %Z�/Ll y Date`7- F Y-O I- Revision Date Conservation Commission Filing Required: YES NO�—& If Yes, Type of Filing: Notice of Intent Request For Determination Of Applicability Conservation Commission Sign -of Signature. :: Date: 4$ Printed on Recydod Paper TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location:�n 9��f94?- 7-C1AN4 2Q. Map No.:_ey Lot No.: / Proposed Improvement: .&Alay f h oA-) Applicant %Fe i rr/P, C"! 32r,-.✓.0r9AJ .7j� Tel. No.:�9- L106)-73 08 zG7 AeAlo.v4 604Y Address: .f;F2/e r,,:uy.r/g r 1-!,Q . o Z C� 3/ Date Filed: 7- 2 S/-o **Ifyou would like e-mail notification of sign off, please provide e-mail address:, Owner Name: H,41L t7 /0 Owner Address: 22 HA iN r 7- /-)MAWiJ /((,4 D2Ga! Owner Tel. No.: 6 / 7472-�9 33 RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit four (4) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note. Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: COMMENTS/CONDITIONS: PLEASE NOTE ie TO MR i xv--d c I 11 eI r0 CIVL. i 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(pgi !ee�4iF4 Map #: Lot #: Proposed Improvement: _H,Q vle- /��,tJ�J,q 7—ra,c� Applicant: z 72/ Tr Ile ��2s=N•dy �2 zG7 MAG,u5--7-G047 Address: H4 Tel. #: Sej - - 2 305 Date Filed: RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location. Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission Determines Compliance to Wetlands Acts; I.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc... Health Department 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 Pro ction; i.e. Smoke Detectors, Sprinkler Systems, Etc... REVIEWED BY WATER DIV SyI N: d2e �L PLEASE NOTE: COMMENTS: TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 026U (508) 398-2231 exL261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-07-038 Applicant Name: Walter Brennan Jr. (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 4525 Net Owed: ($25.00) Application Date: 7/26/2006 Issue Date: Expiration Date Applicant Phone: 5084007388 Building Location: 00369 GREAT ISLAND RD Owner's Name: Martin Reilly Owner's Addres 22 Main Street Hyannis MA 02601 Owner's Telephone: (617) 872-9933 REVIEWED BY: Comments: Map/Lot: 014.1 new windows, doors, roofing, siding, Interior changes, new kitchen, new flooring, electrical service, bathroom renovations, new exterior deck ONING APPROVED 1. WATER DEPARTMENT: DATE: WA: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: DATE: WA: 5. BUILDING DEPARTMENT: DATE: WA: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 7/31/2006 OFFICE MEETING NOTES , ADDRESS: //-1�R�'+ %� DATE: Names of Attendees: Zoning District: Flood Zone: Z) Meeting Topic: 05/05/2006 14:20 FAb 3087713597 ANGELA RAE PHILBROOK lih 001 02/27/2085 15:13 6172546784 (goal Eft co' 7W 7 ONE CAL.(_ PAGE 04 345- GIZ64 -r el FEDERAL EMERGENCY GEmENTAGENCY SwTIOAIOd QIA ft.. -W" STANDARD FLOOD HAZARD DETERMINATION I kouc ve 4Kw"O"c6wjl.20oa SECTION I . LOAN INFORMATION t. L ENDER N ME ANO ADDRESS Z COLLATERAL (BtrAinpv> ftk HpmeiFiarxwW P=wW PROPWay AMPE55 Selective 2nouramee Conpany ILGOW O`rormya 40 Wantaao Ave 369 QWMT isus Ga tea C2T 101 W:9T TILSIN =2, W& 0203 Rramcbrille. NJ 07290 s IMT32f T.RHILLY ALLilr Harold d Salami 3. LENDER ID, NO. 4. LOAN IDENTIFIER E. AMOUNT OF FLOOD INSURANCE REQU9WD 009002000190 $ ' SeCTION ■ A. NATIONAL FLOOD INSURANCE PROGRAM pal) COMWJWTY IURWCT10N 1• URP comemAlf Norm 2. Cowen") I A Stet 4. NFW Conarratily Nranbar T&IDOXIra. TO01 OF 250015 IL NIATUMAL FLOOD INSURANCE PROGRAM (NFIP) DATA APF6CTWC BIRLOIN67YOBiLM How 1. NFIP Map Number or c4nmway Panel Number (Comrnsrrily Name, If not In sane Aa A) 2. NFIP W p Panel EOadnd AWOM Oora 1% LOMAfLOMR A. Flood ZOrw S W NFIP Wp 250015 0005D 07/02/92yes g oaa C. FEDERAL FLOOD INSURANCE AVAOARIL(TY (CLAW[ a0 Nat apply) 1. ig Fadaral Hood knurwi e b w gMW faorransWpartiapa(ay it trn Q RajLAv Program , [] Ema9w cW Pro9Bm d NFIP 2. ❑ Federal Fbw kra gwm is net m2 bble hecauee oonnrpoly in eot Wlbpmkg in (M NFIP. 3. ❑ 6 Home Is Ina Cass410sater r01 Rea= Ana (CBRA) or OOs ww ProtCltd Area (OPA). Faded P Wd Irmw nce may m avaY CBRMOPA DesWaam Dales M DETERWHATION IS BUILDINGIMOBILE HOME IN SPECIAL FLOOD HAZARD AREA (ZONE CONTAINING THE LETTERS "A" OR nr) 7 YES ® NO If M. nwd ImmVica Is rewind by am Flood Disnaw law adian Ad; of 197& u nq Good muftrsaa It not mqukod by era► Flood Obaaler f'mk%lm Ad of 1977. 6 COMMEM (ORtlonogs This defarrww5on is based on axF"1lkg Ella NFIP m p, a y fisft. Ensefperscy W�rapernaG ABe+iry redsiana b R and any cow klfOnrralloa P - R " to bats Q)a bsrbki twbiW horns on 0a NFIP P. PREPAR13M WORMATION rr• NAME. ADDRESS• TELEPHONE NUMBER (f0fia 0*1 farxie0 ;I DATE OF DETERMINATION First Aaroaieam P200d Data Sax. cao 10/28/05 at 12s46 FK CDT 11902 8urmat Road Austin, T3 78758 11e04CGrc #9 031OC94723 1-800.447-1772 t•�' , ewL Form auT, ogo2 a� pw ' �•• mmvalavaracvr TOWN OF YARMOUTH BUILDING DEPARTMENT t PLAN REVIEW & BUILDING PERMIT APPLICATION =v EW Nom ADDRESS: Map / Ld: Date of Initial Review. r 1 OTif 4-g mil" � 171--e 7 Correction Ust 77 No. Description Code Section (For affim me only) zoning Denial (dapplicable)r Section 104.32, Para Chmge. F.xeasios or Alteration (promdctios, 00000a6ormiog) JU peopoaed requires a Spodd Pcm* ft= the Zaoiag Bond a[Appala Otbet Bdilding Code Denial (ifWdabie) h Temp Permit No. Applicant Name: Applicant Phone: Building Location: TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 exL261 BUILDING PERMIT T-07-006 Walter Brennan Jr. 5084007388 00369 GREAT ISLAND RD (OFFICE USE ONLY Recorded By- Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Cash ChkNo.: 0 Net Owed: ($25.00) Application Date: 7/6/2006 Issue Date: Expiration Date Comments: . Map/Lot: 014.1 interior alterations - new partitions and ceilings Owner's Name: Martin Reilly Owner's Addres 22 Main Street Hyannis Owner's Telephone: (617) 872-9933 MA 02601 ' REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: WA: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: WA: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 7/13/2006 oF'Ygk,� ONE & TWO FAMILY ONLY - BUILDING PERMIT o� _ C APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING y Town of Yarmouth Building Departmcut ",,..,C„. 1146 Route 28 • Yarmouth, NIA 02664-4492 Tel: (508) 398-2231 x261 - Fax: (508) 398-0836 Office Use Only Planning Board Information Assessors Department Inform do . Permit No. Date Plan Type Map J 0 6 2006 Permit Fee $ Endorsement Date 2Sf Recording Date N BUILDING DEPT. Deposit ReC'd. $� Date Ian No. 1.4 Property Dimensions: ov: Net Due $ / Other Lot Area (sf) Frontage (ft) Lot Coverage This Section for Office Use Only Building Perm, i m er: Date Issued: Signatu: re Certificate of Occupancy is is not required Building Official Dat Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 3G9 G/LS-A-r _ sC,� ✓,o l2�. 1.2 Zoning Information: Zoning District Proposed Use Al. 1 42�ou 7- It'1i4 . (y2lo73 1.3 Building Setbacks (it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L. c. 40. S 54) Public Private 1.5 Flood Zone Irformation: Comments: Zone BFE: • /�� Section 2 - Property Ownership/Authorized Agent 2.1 Owner of ,r9.aA EY L Cy Name (print) Signature 2Z /94i4 S'T" !`f'Yit( '41AI rS NA Mailing Address O2&0/ Telephone Co / `7- a 7 Z_ 9 9 S 2,2 #uthorized Agent: �T�iQ �. /�fi✓.tJigit% /Z f-S� c,Ali 7- Z Nam (print) Mailing Address AJ. YA A"O ce H s Signature lephone Fax SOFA- 77S—(p 3 3 3 Section 3 - Construction S rvices 3.1 Licensed Construction Supervisor: y lf/A,e T,cle- 0. !:�ief-AIXJ4A) Not Applicable ❑ 7 /yiq 6,4.) is r G[JA y .4 oz�3i License Number 0OV3 8 9 Address 11 Expiration Date /^ 2 _0 Sl ignature ephone F 3.2 Registered Home Inipfovement Contractor: Company Name lUr>7�r�e 612r=,d,�Q.J Not Applicable ❑ License Number 27 53 Address �� 7 �f /jQ a 1j � f— WA y ' Signature TelephoneL It Sa -Y00--7196 Expiration Date —/ 1 of 2 OVER Section 4 - Workers' Compensation Insurance Affidavit (M.G.L. c. 152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result In the denial of the Issuance of the building permit. Signed Affidavit Attached Yes ........ No .......... Section 5 - Description of Proposed Vork (check all applicable) New Construction ❑ I No. of Bedrooms No. of Bathrooms Existing Bldg. 9 1Repair(s) Alterations 01Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: �o tt'rf/� Fho ' v v� v vi °oAxC lyv a 081 el�J4 s _r jaxo PelxAj — NT!zR1n2 /oD40-0Fr d,CIG Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant Check Below ❑ Conservation -Commission Fling (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) 1. Building S 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses 6 additions) p Section 7a -Owner Authorization -To be Completed When Owner's Agent or Contractor Applies for Building Permit I; , MM 7—IA,) « yy , as owner of the subject property hereby authorize A�,GG�7iC �� ����% V� to act on my behalf, in all matters relative to work authorized by this building permit application. teignature Owner Date Section 7b - Owner/Authoriizz'ed�Agent Declaration') yy -,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. G( x 6 T�i� 0. <--;a /.(J�i✓ �� Print name Signature of Owner/Agent Date V 9.15-99 2 of 2 o=°`VAky TOWN OF YARMOUTH 00 ���.5,�? BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location:` Number Owner of Property: 4.0* � _ c Construction Supervisor: 19),4 14(! 1>14W.tNA-)VR DDV5&V SOB-5/o0-738< Name License No. Phone No. Address: 7-671 dGNP-r' &ADZ:53 .1 r&ie /� 0263/ Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes & No ❑ If you have checked ygu, please indicate the type coverage by checking the appropriate box. A liability insurance policy Z Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent Signature: Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: JZJ76AiaI<� Est. Cost 0-C, 00 O Address of Work 36 01 �2 40A 7- = LA A2 /J 12D LIA /ego ew Owner Name: "/4/27-0 r;�->et `Zy Date of Permit Application: %- L _ p L I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name •A / z 7y.Y 3 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 Office of Investigations VEi 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Businesslorpnizationrlodividual): ,��2fiJ,c/� t�f �ui e.Or.yL Y'Ysri'�ys Address: e O HIV >-� lrFS rr D, u N t z City/State/Zip: �`64- Phone#: .50,9-Y,00 -7 3B6 Are ou an employer? Check the appropriate box: i.XI am a employer with 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. t These sub -contractors 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. ❑ Ncw construction 7. Remodeling S. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I LEI Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # 1 must also till out the section below showing then workers' compensation policy information: t Homeowners who submit this affidavit indicating they are doing an work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers' cornp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: 1 /y Policy # or Self -ins. Lie. #: 7a / 58&3 D /Zdd Expiration Date: / - 3 t - O 4- Job Site Address:,—;69 tyaT S� JD l/J y 96120City/State/Zip: f�i.%QQhbuY o2��3 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the rains and penalties of perjury that the information provided above is true and correct. Orieial use only. Do not write in this area, to Be completed by city or town official. City or Town: Permit/I.icense # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their enloyees. 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), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the -members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employces, a policy is 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 sbould 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. Self -insured companies should enter their self-insurance license number on the appropriate line. City or Town Offlcials 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 perririt/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or 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. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia TOWN OF YARMOUTH 1146ROUTE28 SOLTTHYARNIOUTH NIASSACHUSET17S02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING 114axNy7tNi� GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 2&9 6�Q e47- -714-4 ✓-o 9/-)- Work Address is to be disposed of at the following location: IV LC/ f-O — DvlyRS7�94 S Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature vlplicant Permit No. 7-6 -a Date TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 261 Fax 508-398-0836 BUILDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work:_ 36 6 ,2fx 7 1s4oul o �,a ,eiOu)-tv Scope of Proposed Work: Date: �7- 6 -D 6 Based on the scope of work described above, the applicant is required to obtain approvals/sign- offs from the following departments as checked -off below: Health Dept. - Town Hall Phone No. 508-398-2231 ext. 241 Conservation Comm.- Town Hall Phone No. 508-398-2231 ext. 288 Water Dept.- 99 Buck Island Rd. phone no. 508-771-7921 Old Sings Hwy. Hist. Comm.- Town Hall phone no. 508-398-2231 ext. 292 Engineering Dept. -Town Hall phone no. 508-398-2231 ext. 250 Fire Dept.—Capt. Kelleher, 96 Old Main St. So. Yarm. Phone no. 508-398-2212 Other Appropriate plans and/or application shall be provided to each of the departments checked -off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for cooperation. Receipt s Signature 7- 6 -0 6 Date •' � '�i a �amsnanux�alGi o�✓it!a4fao%uul3 Board or Building Regulations and Standards HOME IM PROVEMENT CONTRACTOR - Registration:_ 127453 Expiration:, :11/1/2006 Type:, Individual WALTER C. BRENNAN. JR WALTER BRENNAN;-JR':.. 267 MAGNET WAY BREWSTER, MA 02631 Administrator ✓L &,,,1R4Nawak1, O1A&aloco we4 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR e Number. CS 004389 L Birthdats:01/21/1951 Expires: 01/21/2008 Tr. no: 13089 Restricted: 00 WALTER C BRENNAN 267 MAGNET WAY G-- BREWSTER, MA 02631 - Commissioner 0 TOWN OF YARMOUTH BUILDING DEPARTMENT t PLAN RENTER► # BuiLDTNG Pnwr APPLICATION REvEw NOTES C'ALC!> 'f�A peem i r Cosr ADDRESS: MV I Lac: Date of Initial Review: OTif 69 i Correction List No. Descri Lion Code Section (For ofoe ore only) Za ias Denial (if i Saxioa 104.3.2, ywa Chem,, F.rimrioa cc Abmdioa (po-cd� aoo ahmibW 7u pcoporod raquuni a Sp=W Aamit Snn the Acing Bond c(Appalr. Other Boildias Code DcWa! (if gvHcabk) 05/08/2006 14:20 FAb 5087713597 ANGELA RAE PHILBROOH Q 001 02/27/200b 15:13 6172546784 (508) Yic0,7" 7 DE CALL PAGE 04 FEDERAL EMERGENCY MANAGEMENT AGENCY see The AOadaed O k[B /ib 3087-02d� STANDARD FLOOD HAZARD DETERMINATION + exo:aaO=6Wtt, 2= SECTION I •LOAN ■WORMATION q. LENDER NAME AND ADDRESS 2. COLLATERAL fft#WW P ftk hbox zonal ftowW PRCDERTY ADDRE59 seleat ive Xnaozanae Ca vary Rega' 0"4* /on ffw7' be aWMlco 40 9fantagre Aviv 309 92MT ZSZJ= ZD Cs 201 NP.)iT YWHOM, 1Q 0202 Branchville. NJ 07890 jgxra Aa MIRT33 T.RBILLY ,b=& Harold J Salant 3. LENDER ID NO. a. LOAN IDENTIFIER d AMOUNT OF FLOOD MISURANC.E REOUOU D 009002000190 $ SCCTWN ■ A. NATIONAL FLOOD WWRANCL PROGRAM puqn COMuumTy.IuRlBWCTION 1. NFW Conrrwft L Coun448) A Dtafa 4. NFIP Cmrrxirity Nww Nauber TaNumm. TORFt OF n HA L 250015 L NATIONAL FLOOD INSURANCE PROGRAM po" DATA AR=TWG BLUMUGWOOM NOW 1. NFIP Mao Number or Comrnwty Penal Number 2. NFIP Map Panel EfkcWd 3. LOMMLOMR A. Flood Zone NFIP (C"nmwly Name, Moot to same as •Aj Revved Dean I by 250025 0005D 07/02/92 0 s Dom C FEDERAL FLOOD INSURANCE AVAIL"u Y (Check a0 NtR appW 1. (A Federal Flood beurance le a WMW N=rur YO b W-n Q ReqAV Program ❑ Ei m2w cyPmwmdNnp 2. ❑ Federal F bW kreumno6 le no( 2waIbble becaufe oomnxmay in not W(*patlrq kr Bre NFIP. 3. 1] 6ukV iMd)W Home Is In a Cartel Bsater Rewurcec Area (CBRA) or OMerroe Prebecbd Area (OPA). Federal Flood krswance may root be avellablie GBRAIOPA DaobllsOM Dale: D. DETERMINIATION IS BUILDINGIMOBILE HOME IN SPECIAL FLOOD HAZARD AREA (ZONE CONTAINING THE LETTERS "A" OR nr) 7 ❑ YES ® NO If Ye& food ksswance is rewArW by to F heal Dlaader ProWe" Ad d I271 It two food ituxuarm Is not raqufed by the Flood Dhe21 r Pfuk%lon Ad of 1977. & COMMERM (Opoorn0: This delemirWOM is bused an axworny tre NFIP map. UV Federal Em VMw1cY MarrQWW9 Ayerrc7'reViMM b f, ana airy abet kabrfrratbe Medad to bgda fee brllokrOhrwbfe horns m an NFIP P. PREPAPMrs liF oRmATiON e.. .ICOX NI1MF ADDRESS, TELEPHONE NUMBER (OtQip►ihan {arrCerJ / DATE OF DE E.RMWATION Fir8t Amosican Ylood Data 9es+icea 10/20/05 at 12s4a Fri CDT 11902 Burnet Aoad Austin, = 78759 . , i• FI004C% t 0: 0310CS4723 1-800.447-1772 .,.,,,"...r.. Eatiq FOmr i Oct oa ,�„ Rio m lgyrae X 1aNe Pr GCI RECEIVED AUG 0 4 2006 . -_ ��: ear711CY���8��199��i�. l r'�tr�r'.�:.=_ '---• To: Town of Ytlrrmouth Uuilding Inspector From: Harold Salant, One Call Insurance Agency Inc, Re: 369 Great Island Road, West 1'arnioulh, MA 0267.1 De" lnspector• •- Per the attacheci•I`C,IVjr4: (andard Flood hla7ard Determination' located at the above relercnced addreS,r is NOT located in a special flood hazard ar�altlood7one. The prior flood mapdatcd 1986 stipulated that it was located in a flood zone. Upon clarification, in the 1992 map, the actual home is not located in a flood zone. Attached YOU will note thadifference io zoning according to the Fedcral I nteruency Management Agency for NFIF. FFMA is the governing agency for clCtemtining if a property is in a flood zone. Thank you for your consideration in this matter and it'yuu huve any questions, please feel free to contact me. 1. . Sincerely yours, L. arald Salant One Call Insurance Agency, Inc. 4 August 2006 1 121 B TA04ONT STREET, WuOHTON. MA 02 135 i ` 10 CONCono RoAo. SUDCUAY, MA 01 776 M4 eOO-773.5063 USA 800•1$72.8268 BNONToN. MA 61 7.762.2255 FAx & 17.254-0764 r i0 3E)dd. TWO 3No PBLSOGZL19 vz:01 900L/b0/80 03/08/2006 14:20 FAI 5087713597 02/27/2B06 15:13 5172546704 (565) viv7w7 prlbf.La PUL fKLl Wnwn GE CAL - FEDERAL EMERGENCY MANAGEMENT AGENCY Sec TMAM dad 0JABNo-WHOM STANDARD FLOOD HAZARD DETERMINATION '"' gsv& sOaftbWlT,290 SF.CTIOM I • LOAN DIFORMATION 1. LENDER MANE AND ADDRESS Z OOLLATERN. M NwsW� PitPwW PROPERTY ADDRESS R69a,bsow wmohe S01e4tSvp laparmwe Cowp=y 40 Trantage AV" CTT 201 act esz►S SiLATm m NEAT X&RUMM, Ma 02672 Braacbville. NJ 07890 1�R1CCS;r l[&tr31T r.aslr.>:>< A=z Aarold J Sal -at 3. l fJNDEt ID NO. 4. L01114 IDFNTFIEi 3. AMOUNT OF FLOM WSURAMR RWUME0 009001006190 S BCCT1014 ■ A. aATKn&L, FLOOD INSURANmPROGRAM VMn COMW errrJuRl9o+CTIOH 1. NRP CommulYtr Z. Lb.414e) A State 4. NFIP C wmwnit/ Name Nuaaer X&Tism xa. TORN Or tm 250015 IL NATIONAL FLOOD INSL4RAW:E PROGRAM VWM BATA APAF6CTWG BIA.DIMNYOU F HOW 1. NFIP Map Nwnba or CA m wtY Paid Numbs 2. MJP Mao Pand EoXmd I LOMNLOMR A. Floar Zq e S No NRP (CDowru+Z11 Naas. r not OM aline m W) Rcvow Osto Map 2.90015 0o05D 07/02/92 8 Yesoft G FEDERAL FLOOD INSURANCE AVAU ABLr Y (Cck hoa0 uwa v4wW 1. Qz Fadar9l food kuurmtoe se atidYlple /oor+mrniYP as n 14r�1 Q Pro9r911r ❑ Emmgwuy Pn�rpfm atNFlP 2. [j Fedem Fbao ireuranoa Is nd aralmWe bo mee oownwary it ao4 poridpariv it W4 NFIP. 3. ❑ Home b Ina CmsW 9sater PAxmLj K Area (CB" or0V%uw o Hord Nee (OM Fedog Flood ►araarloe may no GO RIVOPA DoWonoom Daft D. DETUVA NATM IS SUILDINGIMOSI►.E HOME IN SPECIAL FLOOD HAZARD AREA (ZONE CONTAINING THE LETTERS "A" OR "V") 7 (] YES ® NO KT4s.Ilmd bwaama Is realred ty 9n Fbod Dlasdar Promedan Ad of 19M 1I nq Good bsaarrm Is not ra4rifd by Ole Flood Olea kr Pmkckn Ad of 1973. F» COMi(Ef(it3lOptbrLaQ: Tlro delanrnfaon Is 0®ed on axpririrq at NiIP msa� ary Faf EmuDaq Masspsnrsrt Alparry ra+ Isiorrs b I< and say roller WOrmsucm rooded to bptf tw &Adlnyrtnbls Vane an On NFIP F. PRFFAR M BWORMATION r • . NAMA, AOORESS, TUJU"ONE NUMBER (Al vow$m 4,a Wwj .I GATE OF DOEMANATLON First Aft4WICan Plood Data 9asvicao I U120/05 at 12e46 FK CDT 11902 Barnet land Anguse = 78759 FlewdC4rt #e 031OC94723 1-800-447-1772 . vtasras as lum" ot UAG Pmtffff Properly Loeadon 369 GREAT ISLAND RD AMPJD.IM 1/ / / . Vaion M. 94 = ; Otke'r ID. 9/ K0821 / / . BW #: 1 Card .1 - of .. _.1 Print Date: 07/05n006 I iwc, trade a 5 o„ucuuaa A -erase+20 qr eL .yV fame Tape the Plumbiag codes Story kcupancy 1 iting't<'all looms Prtns aterior Wall 1 3 Fab Rood lecommonwall 2 4 ood Md")e 'all Height ;oofStrucHip ttun abld :octCocer kspb7GS/Cmp CO.\DO/.1IOBILEHOMEDAT4 ntericrwall l waNSbeet lement 'ode Dewnption 97actor 2_ - - lex aterior floor 1 2 lazdwood 2 loor Adj Tnit Location [eating Fuel [eating Type or'ced Mr -Due lumber of Units 1C T}pe 03 Central umber OfIAN S � Onnuship [edrooms 113 3 Bedrooms lathrooms 4.5 4 In Btbrms COSTAL4RdET 1'.-ltC 4TION taadj. Base Rate 105.00 'otal Room iu Adj. Factor 0.92188 lath Type 2 Modern a (� Indte 1.40 :itches Style- - 2' Modern J. Base Rate 13SM dg.ValueNew 444.777 ' ear Built - 1971 Tear Built 1977 rml Physcl Dcp 25 unto[ 06slnc zoon Obslnc peel. Con& Code peCond0i 0 0 MIXED i WE 1013 SFRAVATER 100 75 prec. Bldg Value 333,600 OB-OLTBCILDUG Ac 1:IRD ITE.IIS(L) / 1 F-BCILDI.\G LATRI FF-47URES(B) Code Desch hon LB I Chats U"Irpnee Yr. Dn Rt 960nd Arm lbhie FPLl REPI.AC'E 1 ST B 1 2.20tt,00 1977 1 100 1.700 FPO CTRA FPL OPEN B 1 800.00 1977 1 100 600 - OOS PEN OPT SHONE B 1 0.00 1977 1 100 0 PATI ATIO-AVG L 280 2.50 2001 0 50 400 DM1 S-RE4TITE L 140 t 2_f00 2001 0 75. 2,600 FEP orcb, Enclosed, Fbdsbed FGR "&race FOP orch, Open, FW%hed , FITS TpperStoMFinished Pro ado SFB Semi-Fhdshed M1)K Rood 0 575 403 91.98 0 528 211 S1.16 0 665 133 27.10 6 476 476 135_52 0 540 27 6.78 0 1,188 713 81-33 0 946 95 13.61 Property Location 369 GREAT ISLAND RD AL4PID: 14/ 1/ / / Hfion M. 94 Other 1D: 9/ K082/ 11 Bldg #: 1 Card 1 of 1 Print Date: 07/05/200611:06 CURRENT 011 i]ER TOPO 11TILITIESIURTIROADI LOCATIO.Y CC'RREW AS.SESSVE.]-T Y MARTIN T . .. 6o�'e Street aged nbeaban Desrn non Code • raised 1'ahie Assessed {blue ' - 69 GREAT ISLAND RD "EST]AR11IOiTTH.11L] 02673 d15 T.IR1101TH,3LI o8io� btic ll'ate S LAND SIDNTL 1013 1013 " 1013 8a1900 33.5.W 3.000 81190o 335900 3,000 r reptk SCPPLEVEaTAL D-I TASIDNTL dtaonal Ownen: "ccovm n 0002200 ubdhision 130 - -lboto ` ' LAN NBER 26D SION ISID:94 - Total 1180.800 1.180.900 RECORD OF0117 ERSHIP BI%IOL/P.4GE SALE D4TE wAt iW KALE PRICE :C PREI7OUS.4SSESS.JEWS (HIS 1) MILLY hLARTIN T D1017763 11/02/2005 Q 1 2.000,000 Tr. `ode Assessed Paine Tr. Code Assessed 1 !)hie Tr. Code Assessed l ahie COCONNORLLC C.00ONNORLLC CONNOR LAR RENCE C _ D928615 C169748 07/07f2003 07/072003 IT I I I 1 0 1F Z006 z006 006 1013 1013 1013 841900 335.900 3.000 006 006 006 1013 1013 1013 74.3200 33'&M 4.200 005 005 005 1013 1013 1013 743200 335900 4.200 1.180Ji0o Total.. 1.083.300 Taal 1.093300 ECEIIPTIOAS OTHER.-ISSES,SMEA7S cis signrdrrre acknowledges a iisit by a Data Collector or Assesso. Year ' Tire Descrinon Amornrr Cale Desrn non Number Amemnt Comm.Int. 4PPRUSED 1:4LC'ESC.1DL4RI- Appraised Bldg. Value (Card) 333XM Appraised XF (B) Value (Bldg) 2200 Appraised OB (L) Value (Bldg) Apptaised Land Value (Bldg) Special Land Value 3.000 841900 Taal A'OTES 160 SQ.FT.OF FLOATING DOCKS (75%) - LA Total Appraised Card Value 1180.800 Total Appraised Parcel Value 1180im Valuation Method: Cost/11Iar1mt almetlon et Total Appraised Parcel Value 1,180,800 BUILDING PE VIT RECORD 17SIT/CHANGE HISTORY PermnlD Issue Dore Ti7v Lk-scn non Amami Ins .Dare 96Com . DareCom . Comments Date ID Cit. hirposeResulf 01-561 2/28/2001 RS leddential 16-W .482002 100 1/1/2002 D FLORIDA Rbl 0 11118f2003 KF 02 Ieasnr+211s1t - Into Ca 00-63.3 3//02000 RS _ lesldentW 12.500 5/8/2002 100 1/12002 FINISH OVER GARA( 9=002 IT 00 leasnt•+11sted 747 1020/1998 AD Wdiflon 35,000 .V25/1999 100 1/12000 Z CAR GAR. CONVER 41232001 KF 00 lensw+Llsted 268 149/1996 PUS lesidenthd 3 S00 100 ItI/1997 REROOF 1)262000 G11I 01 leamr+111s1t ".V1999 G\1 01 Ieasar+Mdt 11f7/1995 DIH 02 1eae'+2"1sit-Into Cs L4."D LI.\E 1 A L U A TIO.YSECTION - Use Code Lksrn non Zone D --ron"el Lh th Units UmrPnce I. Factor S.I. C. Factor %bbd. Ad. I Xorej- Ado S al Pnente AA. UnlrPrlce Land 1'ahre 1 1013 iFRIVATER 19.730.80 SF 6.77 295 9 2.25 00" 1.00 Z10x90topo +L95 841900 Taal Card Land L'nin 18.7J 1.00 SF Parcel Taal Lond ties: 1&731 SF Taal Land f bW Sa1900 AA* ,3� �icEAT ,f .c,ti,ld � p0 [/ E�•,moo oJ'E.D �.c/al/A�j°�! ��Cf%2dQGlGT DI✓ oA� fI/ •cO E a! O� �' 6 0 /Alr I Af �a II ayW,I G/y��6' ,��,ac 402 II II ewz� II II f A T ✓' G Goti /N��D I II II � II 7 IC/E 1,0 3 EM lzzzeicN' 12&-r /,c.� �� ,jai✓ off' 00 e G L ,cl Pa /?'7,9 Al I c000 �Ar� tl ! C6 GooJ /Ll/G 12IJ �4!eiCOblllelPl-1 ii I I I� A�/-/ (. " . a I T e .. . .-- —y� �� it I z I I ICbo �'�-� .f-u�• re L ate. I I r ✓ � �r-c�n� I I I O 26r,� -- .� 4.rL S� P ass • %'?-� II /001 II II ,� v/ .J I I ,fit pp- CF y,TR T (A • M�TTACM[[1 ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 Office Use Only Permit No. --a I Date % 14 V Permit Fee $ Deposit Rec'd. $ a P Date Net DUB $ D Planning Board Information Type Endorsement Date Recording Date No Other Assessors Department Information: Ld / New 1.4 Progeny Dimensions: Lot Area (sf) Frontage (ft) Lot Coverage This Section for Office Use nly Buildind Permit Number. Date Issued:. Signature Building dal Dat Certificate of Occupan „� required Section 1- Site Information I Use Group: R•4 Type: 5-B 1.1 Property Address: 369 G a f?A'r � s L4 AJ.o /-;-> �> . 12 Zoning Information: 9Z Zoning District Proposed Use W. ySq,PHOK,1y`f0 �yA 0 2 & 73 1.3 Building Setbacks (it) Front Yard Side Yards Rear Yard Required Provided Required Provided Re uired Provided 1.4 Water Supply (M.O.L. c. 40. S 54) Public Private 1.5 Fbod Non:. Commends. Zone: BFE: Section 2 - Pro arty Ownershi Authorized Agent 2.1 Owner of Record: 77/J ^�r/zZ Y ST ,i/r/ 5 / 62 Name (print) Mailing Address 14 / 7- - 33 Signa ure Telephone 2.2 Authorized Agent: y /[�fI j- 7-f,2 C`'• "'32 fit l.clA,J Vim A rM Mc F s r Rp u,� / T 7- Name (print) Mailing Address (D 50 , - 3 GAl, �.qR Hou7 N HA O z1.7 3 Signature Telephone —6 3 3 3 Section 3 - Construction Services 3.1 Licensed Construction Supervisor: L A- JUN 0 8,2006 N tApplicable ❑ 2-&7 HAGv4r 4JAy �j2f.�sT BUILDING DEPT. : Li ease Number OD(13 Address SO — OD — tip Expiration Date /. 2 / _ Z o v F3 nature Telephone 3.2 Registered HoAte improvement Contractor. Company Name L 7f4 f t ,VA Not Applicable ❑ License Number 3 Address 7-&7 m,4 e-1j & *r cJA y C�3gf.)Srl/z H•Q- OZ!L3/ Telephone SO pI - 3 bu Signaturf,061 Expiration Date / 1- / — b (o O/ 9- 1 of 2 vvcn Section 4 -,Workers' Compensation Insurance Affidavit'(M.G.L 6.152 S 25C Workers Compensation Insurance affidavit must be completed and submitted with this application. Failurq to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes . V.. No .......... Section 5 - Description of Proposed Work (check all appgcable) New Construction ❑ No. of Bedrooms _..�— No. of Bathrooms Existing Bldg. 0�1Repalr(s) ❑ Alterations Er I Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: AIA 4x_ f :C10 t/f; i-7O — O2 f _S — ,cJ i a) /e00 F. A) — fu� Siof,cJL -- 4��td Nct>�,cJ,OvcvS— N�`i.¢io2 LA Lf ,Jlof — / a B i''*-i°o.J AS CAA) Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by per7ft applicant 1. Building Z SU (qt' 2. Electrical p 3. Plumbing / Gas 2ej ,-3d 4. Mechanical (HVAC) 5. Fire Protection 6.Total=(1+2+3+4+5) 7. Total Square Ft. (new houses S additions) Section 7a - Owner Owner's Agent or C I f� -To be Completed When ies for Building Permit Check Below ❑ Conservation -Commission Filing (if applicable) Old Kings Highway & Historical Commission approval (if applicable) , as owner of the subject property hereby authorize 1, J1A_ df n �9 i� &i V to act on my behalf, in all matters' relative to work authorized by this building permit application. Date Section 7b Owner/Authorized Agent Declaration [4 %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. Print name Signature of Owner/Agent Date 9-15.99 k / 2 of 2 TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: job Location: 369 PpaleA r 1sl iI41 OOZG73 Number Street Village Owner of Property: �2A 2 Ti r/? fr u y y Construction Supervisor: IdA I T e4 [7"�OIUWKA% JA 00V399 S�8-t/Db-73g� Name No. Address: Zl.-7 Y A& ) �*" LAJ A i T32P "Z rf•e_ "/I Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. Phone 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes N( No ❑ If you have checked yam, please Indicate the type coverage by checking the appropriate box. A liability insurance policy ill 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._Gerlerall Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner ent Owner ❑ Agent Signature: Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by re gB sered contractors, with certain exceptions, along with other requirements. SfLfc7-/✓ Type of Work: I&W J,—< Est. Cost 32 Address of Work 3&5 65/2847- -7sCQ,12iO .eO. w AAAf7ovi`i'/ Owner Name: YK2 7 7/-3 Date of Permit Application: f7 �s 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: �J.f J 7,,e- oo y3 e 5 Date Contractor Name Registration No. OR Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name ,per The Commonwealth of Massachusetts Department of Industrial Accidents Ogee of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information - Please Print Leeibly Name (Business/organization/Individual): 312f',yxJ/ cfr- �jU/ c A .y 4. y /YS S G,e en Address: Z City/State/Zip: Phone #: _4S;_00 — 4/OD-- 7396 Are on an employer? Check the appropriate box: Type of project (required): 1. FI am a employer with /_ 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).' have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet = 7. [0 Remodeling ship and have o employees Thew sub -contractors have 8. Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL I LE] Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box # I must elan fill out the section below slowing their workers' comperuetim policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tcontractors that check this box trout attached an additional sheet showing the name of the tub -contractors and their workers' cmip. policy infortation. I am an employer that is providing workers' compensation insurance for my employees. Below it the policy and job site information. Insurance Company Name: A 77 H- Policy # or Sclf--ins. Lit:. #: ?D/ 686- 30 / ZOO i✓ Expiration Date: / Z -3 1- O G Job Site Address: 3G9 6- t24-AT TS LAa 0 �� _ City/Statcaip: to. trW e oz`73 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 impnsonr=4 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 c� certify under the pains and penalties of perjury that the information provided above is true and correct. /n Cionnnim. / ., //D C�t' Date: SOB LIOD - Official use only. Do not write inYhu area, to Be completed by city or town of xkL City or Town: Permlt/Llcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,• express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings In the commonwealth for any applicant who has not produced acceptable evidence of compliance with the Insurance coverage required." Additionally, MGL chapter 152, §25C(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), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does 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 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 appropriate line. City or Town Official 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. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write •'all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would ]fife to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-2&05 Fax # 617-727-7749 www.mass.gov/dia BUILDING TOWN OF Y A R M O U T H ELEGTRICAL GAS 1146ROUTE28 SOUTH YARMOUTH MASSACHUSLTTS02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 PLUMBING SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 3loc/ t7'8—f[ftT :77,exJAJ Q 5-AAf/v Le-r 1, HA O ZL 73 Work Address is to be disposed of at the following location: /d a /'E 7-'> CFAs T z S YC %r,4/- 3 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. S -g -o co Date Permit No. T_[i@E0MIED ot: Y�ky TOWN OF YARMOUTH MAY 0 9 2006 HEALTH DEPARTMENT HEALTH DEPT. "'-•��'' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 3(o9 G2rA7- ..1.s IxAjlj /24) Map No.: Lot No.: S Proposed Improvement: 370,Q 0 0 HA J D,e Applicant: bVA L-T<-_2 0.' b' tZ ti,a,y,¢� j&- TO. No.: S08 - Y00 --7 3 S 8 80MAThor(elfe'PO uNI7r2 &J,V4f2WDV t-*1 "A 02C,73 Address: zto7 MA 6A-) t: T ri-m R_�vcJS E,,c �fyd Ozy j Date Filed: -o L +*lf)vu would like e-mail notification ofsign off,please provide e-mail address.'BRF,u N I c k Bct i i o',,e)4, Q C'om Sr. ,u FT - Owner Name: NA12: a iCL'-1 Owner Address: ZZ MA1,J 9 '1 Owner TO. No.:-6 1 -7 - 0721 -99 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. REVIEWED BY: Please submit four (4) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. TE: �--2/0 /0 6 PLEASE NOTE (v1u5-F /� rv�� �N 13ci rvov�S 1jau-s ` «AYq //,rcf cA/0C 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(vcI 1/LQA7 15(ja,uD Map #: Lot #: Proposed Improvement: cx T 4,urt✓� �L.y� I/.q 7 o N Applicant: Ol9e- 7-,ix ("-,- alzegww-) BDMAMA►ctS`, Je0. 2 aV•YARHou Address: zk,?HAGt1t zyAy-fe,,Tel.#:Stz5-L/co73&B Date Fled: T-3i -0 S- RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location. Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc... Health Department 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 W TE DIVISION� signature date PLEASE NOTE: COMMENTS: Signature Of Applicant Date: NAME Y.., • STREET369 GREAT ISLAND ROAD IDT 82 VILLAGE ld ST YAMIOUTH SERVICE NO. __ 33 1 V9 %247-7 �}3� I Hya. �/ 4 ,1 k 321Q° 431p1, 1810', 14, GREAT ISLAND ROAD WEST YAR14OUTH SERVICE NO. NAME g&)fenee VILLAGE WpS-r /..J•armO METER NO.Cn'I<C> .3 1yeto 57, emu icc U'a d •J w .r Gr-re0.+ ..1 S long Poad Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR p Registration:_127453 ,,Expiration: 11/12006 Type: Individual. WALTER C. BREt r" JR WALTER BRENNAN, JR - 267 MAGNET WAY'"='. r r. ;ram-���c..� BREWSTER, MA 02631 Administrator Ole TCanr,aon�aeall� n� ,l�+.uuutuJel�i ' BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 004389 Birtl date: 012111951 ` Expires: 0121/2008 Tr. no: 13089 Restricted: ,00 WALTER C BRENNAN 267 MAGNET WAY (/ BREWSTER. MA 02631 Commlasionar 03/08/2006 14:20 FAI 5087713Z97 MbDLA NfD ru&LAmwu e2Y'27/2ees 15:13 6172546784 �50a� �.744 7 OW CALL PAGE 04 FEDERAL EMERGENCY MANAGEMENT AGENGY SeeTMAbmdred STANDARD FLOOD HAZARD DETERMINATWN iiQGi°°��• 2005 SECTION I • LOAN BiWF4MATM 1, LENOF3t NAME AND ADDRESS 2 COLLATETtAt f n0 a FRans l9DrIaI Pltpa0� PiLOPF�iTTADORRS RegalOeea"'anmobeS Salaative uouran4a coxgxmy 40 Yrantage A+M 399 QWW1Wr SAL87m ZD ca 201 11= XL2kVRi)E, ML 0203 Branchville. NJ 07890 I 1fARTSlT T.88ILLY : Harold J Smash 3. L e4DER 10. NO. 4. LOAN IDENTFIER S AMOUNT OF FLOOD IN&NZAK" RE WffMD 009002000290 $ BeCT10N ■ A. NATIONAL FLOOD INSIIRANCEPROORAM POW) C0MY1Jea1TAUR33D=flON 1. NFlP COMRLNV r Name 2. 4. NFTP Ca inwr4i Number xLwzm . Tom or 1a 250015 IL NATUA"FLOOD ManWA EPROGRAMRVW)DATAAPFWTV=BUL=M WOBILF-IMM I. NFIP Map Numbs of Caanvurty Panel Number 2. NRP Map Panel Etna ivd 3. LOMAA OMR A. Fbal Zvr 6 NO NRP (Cwimunill UMV. Q nab 01a aamo as'A') Reveod Dam Map 250015 0005D 07/02/92YM s Onto C FEDERAL ►LOOD INSUR4ra'� AVAUliAILRT (ptwk MI UNA tlpplirj 1. IM Federal Rood koutan m Is ale0ebie (cmmwm*p kl WK QQ RegAm Pm9mn ❑ E3ltw2wW PM9rwn dNnP 2. [] FOdeml Flow kwurmm is rot avallabla because mranedly i, nob padic palkV In ft NFIP. 3. [3110clOWMabile Nome is In a Carmel QsffW Ramutae Ana (WRA) or Other+ee Proketsed Area (OPA). Fadmd Powd ktsuranoe may rm be Ave C9RAIOPA Daalpnmum DarC 0. DETERNU"TPN IS BUILDING/MOBILE HOME IN SPECIAL FLOOD HAZARD AREA (ZONE CONTAINING THE LETTERS "A" OR "V") Y [] YES ® NO N Yes. llaad ktsu mm is m"%d by tm Find Olaadm kwaebat Ad of 1971 If no. rood'emantm Is ra m*ah d by live Rood Dhae)er Pmkec*m Ad of IV& E. CO)I RLW8 (Opdw4: Thi deb3o*mvon is bmed on aaanni"o the NFIP mum airy Federal Emwgwwy Maseaemenl Age wr revisim b iL and any edw Wormucla6 needed to boats fta bu- m -mmoDra hone on h NFIP F. PftEPARGRS INFORMATION r • . NAtlQ AODREw, ig EPi1ONE NUeeBER (io0.e►Maa Lander) / DATE OP DEEFRMNATION PirBt Au=:Lcan Flood Data garvLcepul10/28/OS at 12s46 PK CDT 11302 Bu at Road --- Anetia, 17C 78758 F100dC41rt is 0310CS4723 1-800-447-1772 . ,,low,.._ . W" r rrsawM erma: a as rambo x UAG Pm—r Temp Permit No.: Applicant Name: Applicant Phone: Building Location: TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT . TRANSMITTAL T-06-509 Walter Brennan 5084007388 00369 GREAT ISLAND RD Owner's Name: Martin Reilly Owner's Addres 22 Main Street Hyannis MA 02601 Owner's Telephone: (617) 872-9933 REVIEWED BY: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Cash ChkNo.: 0 Net Owed: ($25.00) Application Date: 6/8/2006 Issue Date: Expiration Date Comments: Map/Lot: 014.1 selective interior demolition 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE CO MENTS: RECEIPT OF COPY: OF APPLICANT: DATE: Date Printed: 6/9/2006 a m a m u O In 6 Z. i C 4 ( I '"--,FIELD COPY BUILDING PERMIT,>�ri.00 �33�� DATE 1'c1 106 2m 14�_pEl3 (k11T O. ��3 APPLICANT RLcb� P. � ADDRE�S t ~p�$��0 a Y+a • (N0.) (STREET) (CONTR'S LICENSE) PERMIT TO (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) DISTRICT 11.� (N0. (3 BEET 1 BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION 14/1 LOT =2 BLOCK "'T 9 SIZE ti { BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR OUNOATION ����==��LL ��y,�� y,� (TYPE) REMARKS: Pmish � e i2stim xo= �S aye � �it�-�i � Id=. f r in _7T_Tr%aod Wet bw =ea. AREA OR PER1l.PW.W VOLUME ESTIMATED COST $ FEEMIT $ 131W (CUBIC/SQUARE FEET) OWNER T ' m C. olcxr(= i .ADDRESS -- 11$'�rnl no g� Nert, In -43n4n BYILDING DEPT. *. IT INSPECTION RECORD DATE NOTE PROGRESS - CORRECTIONS 'AND REMARKS INSPECTOR al 4CC eO� I b ONE & TWO FAMILY ONLY- BUILDING -PERMIT C APPLICATION TO CONSTRUCT, REPAIR, RENOVATE aA DEMOLISH A ONE OR TWO FAMILY DWELLING O y Town of Yarmouth Building Department '....C„° , 1146 Route 28 • Yarmouth, NIA 02664-4492 Tel: (508) 398-2231 x261 - Fax: (508) 398-2365 Office Use Only Permit No Date AL00 CK 16'1g Permit Fee $/y3, I Deposit Rec'd. $/61 Datel:3� Net Dud $/3 Planning Board Information Plan Type Endorsement Date Recording Date Plan No. Assessors Department Information: Mac or /,M/tar Old New 1.4 Property Dimensions: Lot Area (sQ 3r Frontage(ft) Lot Coverage Other This Section for Office Use Only Building Permit Number: Date Issued: Signature: Building Official Date Certificate of Occupancy 1/ is Is not required Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: .�� 4 6 j?n4 i 6,g v D J aAy 1.2 Zoning Information: re Zoning District Proposed Use -7s W. yZzgt?9O U7A ZQ 1.3 Building Setbacks (it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 36 � as 217 yp 1 a 1.4 Water Supply (M.G.t. c. 40. S 54) ublic Private 1.5 Flood Zone Information: Com "I'll Zone: _ EIFE: WAR Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: �, r 4oL �4 r e i C Lea Name (print) I oo Mailing Address kt 'W C D 7 FL .33YYd- Signature " Telephone 2.2 Authorized Agent: aA*1A * L-> R N (p int) Mailing Add2ss -gignature Telephone O G Section 3 - Construction Services 3.1 LIcpnsed Construction Supervisor: 17 6A Z ME-4 U Not Applicable ❑ ,IIAR 1 License Number 00 G %l T Ad Expiration Date o41og1c;,OD0 i ature Telephone 3.2 Registered Home Im rovement Contractor: Company Name c;�•S/ DO D Sl D t! NO GA,?1i/ coA a :, w' '�A ZNSTiP 1�1 Not Applicable ❑ License Number 10003 s �J-AhQ � Signature Telephone Expiration Date O,6loft 1o1AD6 of P 9 - 15 - 99 1 of 2 OVER Section 4 - Workers' Compensation,lnsur nce Affidavit (M.G.L. c. 152 S 25C ( )) , Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ......... No .......... Section 5 - Description of Proposed Work (check all applicable) New Construction ❑ No. of Bedrooms No. of Bathrooms Existing Bldg. Repair(s) ❑ Alterations Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify,_ f�ECt7EATio.y /�oor✓1 Brief Description of Proposed Work: AA k;g r;'� D r/ iZ c) / - Ai G o f Costs Section 6 - Estimated Construction Item Estimated Cost (Dollars) to be completed by permit applicant Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old I(ings Highway & Historical Commission approval (if applicable) 1. Building oo 2. Electrical a'o 3. Plumbing / Gas p 4. Mechanical (HVAC) oo 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) "— oD 7. Total Square Ft. (new houses S additions) l% Section 7a - Owner Authorization - Owner's Agent or Contractor Applies To be Completed When for Building Permit I, 44009C QC F C. D (( ,-JAZOa , as ownffr of the subject property hereby authorize OCs/,4R 0 ,R i5 4AR VEA U — to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Section 7b`- Owner/Authorized Agent Declaration I,r/�AR17 }? GA7NPi4(1 �� ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. . rA-1?NrAo �2 ,;?Lc1m,zb Print nam � 000 Signature of Owner/Agent Date 9-15-99 2 of 2 TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARNIOUTH biASSACHUSETTS026644451 Telephone (508) 398.2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING 1010 GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at l<;Ef 17- 1 S 1AW Z-> �0.4 l7 Work Address is to be disposed of at the following location: �,rzr�0�77 //rAi(I -['Z S5 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 111-71, nd Signature of Applicant Permit No. / � •I ► III 3i°YgRc TOWN OF YARMOUTH O BUILDING DEPARTMENT BUILDING /PERMIT APPLICATION SIGN OFF Applicant: Building Permit No.: Address: 6k01%9Q>e IV 461 &W Tel. No.: 105 C�66i Date Filed: 364 6;iZcAT-sLA.vC> RV Bldg. Site Location: W XA hl 601Z, m/1 Map No.: Lot No.: The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMIIIISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc. HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements for Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ---------------------------------------- 77ie followdng Departments must sign off, in the respective order, prior to building inspector issuing the required building permit: REVI1� BY: r WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTD t8 T: DATE: N/A _ DATE: — "� N/A: .CONSERVATION: '�l. HEALTH DEPARTMENT: DATE: 3" 'a N/A. - INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. C0NBIENTS: -L cc o., D K_ 8/99 Applicant Signature Date r°f-ARs TOWN OF YARMOUTH 0C r��=;.S.�y BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location: �?6 q e5i?F-Ar 1-9 L A,l,� Rom( fit% yA7 PAQCJ / A d'(.t' Number Street Village Owner of Property 1-,4W7E,UC i= C'. D'CQe0A1o? Construction Supervisor: lfi cHAZO K 0A1ZNCAtJ. J it yQ/S -� Name License No. Phone No. Address: Licensed Designee: (If other than Supervisor) Name License No. 2.15 Responsibility of each license holder: 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No ❑ If you have checked ygg, please indicate the type coverage by checking the appropriate box. A liability insurance policy 4YJ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Ch er 152 oft a Mass. neral Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent 7 Signature: Building Official Approval: L._ The Commonwealth ojMassachusetts Department of Industrial Accidents Of ea 011"esifyatfoss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicantinformation: P1e9tcPRIIVTTe iWa name �/CiCN.41ib AiZNEAL-k iR location r-16 t W o o i7 5 r D e city fit/- %3A711% e, % sl R l e- phone a --z7 l -4OeS 5 p 1 am a homeowner performing all work myself. 2f I am a sole proprietor and ha%e no one working in any capacity 0 [am an employer pro%iding workers' compensation for my employees working on this job. company name* address - may: phone q• insurance co. _ -- policy N I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who have the following worker' compensation polices: company name, address• L1lY• phone a• insurnnce rn policy N Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a One up to SI.SWAa sadfor one years` Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hrreby c • unde the paint geed penalri s ojperjury that the information provided about !s true and eorrrd Signature r ate Ongr-I nAl,,>1000 Print name hone official use only do not %rite in this area to be completed by city or town official city or town: YARMOUTII _ permiolcense 0 nBuilding Department ❑Ucensing Board ❑ check if immediate response is required 261 ❑Selectmen's Omee ❑Ilcalth Department contact person: phone M: _ (508) 398-2231 est. 001her as.nsd ).vs rest Information and Instructions Massachusetts General laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an 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. \1G1_ chapter I5-' section =: also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonv ealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The af'Udavits 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 n call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents ftilCe ellmsullitlsos 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 Suggested Affidavit for Home Improvement Contractor Permit Application For omce Use only Ptrmll No. Date NAME OF CITY/rOWN AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGLe.142Arequires that the"reconstruction, alteration, renovation, repair, modernization, conversion, inprovement, removal, demolition, oeconstruction of an addition to any pre-e istine owner -occupied building containing at least one but not more than four dwelling units .... or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: i< %1 — Est. Cost.00 Address of Work Owner Name: LAGL)?£-sVt^r 0•'%Ce)A)A)10/? Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under S1,000 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: �q,e9,47z Y. 4417IVC'.4tJ:7 7Z _/DOD3� Date' / Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name PLOT PLAN utbor Is .me t # this is a =ner lot, ite in name street. eo IV FOR LOT # b Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) Well p� I I cA 2.. F (lnt..�.........ft. rear) SIDE YARD 4 I I I REAR YARD I I HOUSE I SET. BACK ..ft. I ` I (lot. . J. �. L . 3....... ft. frontage) 3 � 9 61ZE�i 1 S LAAlD 126AJ) (NAME OF STREET) SIDE YARD FT� b AbuttorIs Name Lot # If this is corner la write in name of other street. Inflation / Supplied by , /V - MARK NORTH POINT jNTTLTll b4. �J �EC�[IKiNO T. WEE& BE ICI _ �..YYI In �� — _M _- Ab12TM 1NTE111oR WAIL. ® ,dY+.TI DAw, Slru+EE fc: M r yl j •ell...r SoyTN SNTERIOR WALL ,&LSTIAIC. CaAZA[IC AMi If 00 , d� �' Ll Ell --- rAST SNE151 IOR. V IiIiu— ii•\T•� i NFSf3P?fRlod uALc .. .__. 2 2'' E.ana. .76v.- - \ sn��p E'Up1E1 rvr2 1 �Q 1 1 S.ttrcgtin 1 LY L-booq M•� "1 ATMOOMS To EvSn NG.n*o12 ZPACE L. WEE& 7 iflLi 8 I! FIrn � ....... _. NaRTN .r.YrrAlOa WAIL ��� ® ,piwTl D!•w� N K DITY...CD S.o+aG./k [.n,MO.. Ma.aS T. l qKW li V� S• yl�'GwTry SoMTH SMJFRIOR �✓Ar-e. . ,&[SJING r..MAO[ Fvlm 9x __ 4ASr.SM.[$/klofl . N6cL .. h{r.�y A.y 21 C H£ST.;Nr[RIOR WAIL .. .__. - - _ - J.CJ .t 6nn✓. hf 4._w� 1J _ - snp Pbplat nooft I 1 .!R S,'11 ATMAVOMS To ENSn NG.nooit SrCE 2G' oll SNfr^a 4 S?1If} AK,f D/ C MEC&. B t =, _. ,*Rr# SN7Fftlo,2 WALL �pMrT DirM- .r Ewe ® 1D d[ Drvn.+/D sf."'u Wr14 IF VT o.,.f p.. e.ARo bouTH SnTER,OR WALv �s•�ry�'ar.�A ,&s-STING 6AZA t f`Aw Jt - 6sr,+� AW Zf K£Sr_TllTfKID,i WILL .. __. 2 2, II N.Vv fur G.u..� 2617-- _ _ _ $11„p i'iApift %IDOM1 ' 1 , r� \ , sarLS�.1Y ; ��tR 0 N[W D.TH �f \. -S'--'�`-- III' —'r ATfRAYDNS To Eu37)M.G,f7D A SPACE LOT 51 a I 1 S: 7A a 0 I AIL , II H1� •' APPROVED: BOARD OF HEALTH DATE AGENT �rl'\Gy,S�Q-O IN i �'�TN NIN4 • W^LL L Ar.T10 CpwrN4 � g,teK SUAfN:E� � I . r 1 -_ 70 7. �B L.L. q 0-7 NOr6 : �ROp01iD GA,>°i4G• T � � sioP/ f/onJ �L�/dT/ o� L�AC/1'.TRENCH s� �'• ,.�1EOf:IEpy''v9FCISTE0. i amp �i�n K t,.094 'R70NAL V ti�ED LAxo "IItiNJIM,o zla4 sire PLAN OYOM ZC.� -f/fOk T, 7EIPOP-ATLY PERMIT- 'We. MAS5 L S. 1992-TL PROPOSED c;/1 RA G E DECK FOR PRO,ECT LOCATION 3 L 9 G ,t iTA T' x. ,4 nND ZZ). 7" Y/).L'MO UT// Mr1Sv CRAIC R SHORT PROFESSIONAL ENGINEER 508- P.O. BOX 1044 398-8311 SOU1H DENNIS. MASS 02660 kAIE i- =20 WE �Q�22I'7B ,IDD ND. REVISED SHEET ! OF ! REFEREfSCE L�.PL,144ZL ELEVATIOIJ5 •DhSED �� h1fzATJ SEA LfiVEI_ FILE.• L2-450 11 MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 CITY: Yarmouth STATE: Massachusetts HOD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 3-3-2000 DATE OF PLANS: 10-1-98 TITLE: New Room over Garage PROJECT INFORMATION: Lawrance 6 Hellen O'Connor 369 Great Island Road West Yarmouth Ma. 02673 COMPANY INFORMATION: Rick Garneau 251 Woodside Drive West Barnstable Ma. 02668 NOTES: MaCheck by Cape Cod Insulation INC. 1 1330 COMPLIANCE: PASSES Required UA - 131 Your Home - 113 Permit i Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA CEILINGS 584 30.0 0.0 21 WALLS: Wood Frame, 160 O.C. 506 13.0 0.0 42 GLAZING: Windows or Doors 86 0.320 28 DOORS 20 0.220 4 FLOORS: Over Unconditioned Space 572 30.0 0.0 19 HVAC EQUIPMENT: Furnace, 85.0 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date 0 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 New Room over Garage DATE: 3-3-2000 Bldg.I Dept.I Use I I CEILINGS: ( ] 1 1. R-30 I Comments/Location I I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-13 I Comments/Location I I WINDOWS AND GLASS DOORS: [ 1 I 1. U-value: 0.32 I For windows without labeled U-values, describe features: I 3 Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location i i DOORS: [ ] ( 1. U-value: 0.22 I Comments/Location I I FLOORS: [ ] I 1. Over Unconditioned Space, R-30 I Comments/Location I HVAC EQUIPMENT: [ ] I 1., Furnace, 85.0 AFUE or higher ( Make and Model Number I I AIR LEAKAGE: ( ] ( Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or ( gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.949 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure ( difference and shall be labeled. 1 I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 180CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): HEATING SYSTEMS: Low pressure/temp. Low temperature Steam condensate COOLING SYSTEMS: Chilled water or refrigerant PIPE SIZES TEMP (F) 2" RUNOUTS 0-1" 201-250 1.0 1.5 120-200 0.5 1.0 any 1.0 1.0 40-55 0.5 0.5 below 40 1.0 1.0 (in.) 1.25-2" 2.5-4" 1.5 2.0 1.0 1.5 1.5 2.0 0.75 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING ( CIRCULATING MAINS 4 RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" ( 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 ( 1.0 1.5 2.0 140-160 0.5 ) 0.5 1.0 1.5 • I' 10D-130 0.5 i 0.5 0.5 1.0 ' I ----NOTES TO FIELD (Building Department Use Only)------------------------- TOWN OF YARMOUTH Application for a Permit to Build No. W7 UPON FINAL APPROVAL Ra---*� /d `'l `I —' MAP !R LOT �2— FEE MUST ACCOMPANY THIS APPLICATION. DATE 19 9S1 The undersigned hereby applies for a permit to build lalil �9� according to the following specifications /G/Zp/ y 1. Name of property owner �._JZieAjra C ,2" (ren046T 9 Tel.77s h`� L Address -�C/,i�AT rz- 441 cut A '40 rl= % 2. Name of Architect (if any) ,it//A Tel. 3. Name of builder -W/egM.,2 ZK41-?, �i�B�� TZ Address 4. License No. DD �� / 14 Tel. 5. Name of Mason Address 6. License No. Tel. 7. Construction address 3( ri 6kr,47-=Ls 4Ai✓ D f Flood 9 8. Date of subdivision Approval plain zone / it) . 9. Private dwelling ❑ Estimated Cost p 6,Q � 10. Multi family 06)[k- a,�a 11. Commercial ElL' kjt �— `� 12.OtherT�/�Z`'� 13. No. of stories 14. Foundation — 1t 15. Materials — Wood ❑ Cement ❑ Other 16. Type of heat — Oil ❑ Gas ❑ Electric ❑ Other ❑ 17. Garage —1 51'2 ❑ 18. Swimming pool - Size 19. Storage shed — Size 20. Stove — Wood ❑ Coal ❑ NOT IN THIS SPACE err Type of room Kitchen Dining Rm. Living Rm. 3- peek 70 r mo �39S-0 o Deck Closed porn Family Rm. Sun room Garage Shed Alterations No. 21. Size of lot: No. of feet front 16 1, q No. of feet rear Jo?4. 7F1 No. of feet deep �S�• 33 22. Size of building. No. of feet front - � No. of feet side �-/ No. of feet rear o:Z� 23. Distance from nearest building: Front Ft. side /I B„ Ft. side 24. Distance back from line or street 31 % From rear lot line 25. H.I.C.R. No. Z 0003 4 LOT RELEASED BY Signature PLANNING BOARD Date Addre Rear Side line i f- ��-•—•-7- rwn 6� ,010 I FrJH906WS R I o rt. EOI A3ovE CALE - EPST/N6 t \� aeon Ga2.eGF AUJ 41 10455HSL OR FuG 906YR CASCme)v7 (IPIVDOW Oj>T10-JS Q new i M Ro ®c4J I4 /�o a'kYo'x�{=��' G 1; lug �•�;�li{I{1 ,--CCU7i� Cr<o s,s Sec. --ASPH.�tT Y. �1 WC��'lfjli'1�- �i114'*}i'I'I yT'`-y C2M rl p'lotiLVO/? G.a�ZAGG -- . 369 d'jerAr Tzi AmD W. (J. yARjvcuT,W, MA. ... ,_.. _.�-:-...._:e a•. ..i e.a.-r_._.•vsa_ .s.�:. .. __:........_�.•v+:v.>ss^•a•..+....a•:.-ra..v'.-•aw..rlr.�.earu:rvwtwma.�•.0 v...m_�... _s .- .�y1.. -.\ a"w&.: :L". �. r •c .+. •'^"' � TY:._-. �.��...�+ L .£ ni ! ,s+w.-r=.�rr, ;-\: R�—a.. is o• r••a- • ts�'rt•+ . vi s s. +-F.• - _.•••.' + .... � L * ` �'.. ' �•�C.,:.•�'3;YG '..i'iir^ -..�.� ._Ary t: _ l�Y :i'�•�Y-ram �.a.��•,^ •.n LOT 481 L oco G a TLH.L 1 i r�1� 5r 33 LoT 8z 1 .^?PxAxIMAT F— G4sooes uslaa . 1:EgG►iIN"A%*w1.) i + I j _ -A-P a. 1Jo .,box i.::;SToL1E bvuvrr_ . _ I I 0-00 fT LIE: £SI nnn1111 T r:!! • . ro T ✓� 5 IexisT^N►C �y , O 6XIST I MCC WAI'K j6 '.Do�K C•O p:1�PA Q0. 1 ! �: I p+.T 10 c "No I ►a4 a�cc SVAf�cE) 1 s p � 3 74 uTlu"w4 kb WALL. ' 74! 7.4 310 CMR 10.99 Form 2 Commonwealth of Massachusetts s ; W Fr. w. ire a pwrw er cm City Town YA R M O UT H APPISMt Lawrence & Helen O' Conno: Determination of Applicability Massachusetts Wetlands Protection Act. G.L. c.131, §40 and the Town of Yarmouth Wetland Bylaw From Town of Yarmouth Conservation Commission Issuing Authority To Lawrence & Helen O'Connor Same (Name of person making request) (Name of property owner) Address 369 Great Island Road West Yarmouth, HA This determination is issued and delivered as f OUOw5: Address Some C by hand delivery to person making request on (date) tF by certified mail, return receipt requested on rote *�. 5 , 19g a (date) Pursuant to the authority of G.L c.131, §ao. the Town of Yarn. outh Conservation Commission has considered your request for a Determination of Applicability and its supporting documentation. and has made the following determination (check whichever is applicable): Location:StreetAddrass 369 Great Island Road. West Yarmouth. MA Lot Number. 1. 0 The area described below, which includes all/part of the area described in your request, is an Area Subject to Protection Under the Act. Therefore, any removing, Ong, dredging or altering of that area requires the filing of a Notice of Intent. 2. it The work described below, which includes aWpart of the work described in your reouest, is within an Area Subject to Protection Under the Act and will remove, fill, dredge or alter that area. There- fore. said work requires the filing of a Notice of Intent. Effective 2.1 3. 0 The work described below, which includes all/part of the work described In your request, is within the Buller Zone as defined In the regulations, and will alter an Area Subject to Protection Under the Act. Therefore, said work requires the ffiirtg of a Notice of Intent. CONDITION: A silt fence shall be installed 10 feet from the proposed foundation on the wetland side. . This Determination is negative: 1. 0 The area described in your request Is not an Area Subject to Protection Under the Act. 2. O The work described. In your request is within an Area Subject to Protection Under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. 3. J°1 The work described in your request is within the Buffer Zone, as defined in the regulations, but will not alter an Area Subject to Protection Under the Act. Therefore, said work does not require the filing of a Notice of Intent. 4. 0 The area described in your request is Subject to Protection Under the Act, but 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: Issued by G Commission This Determination must be signed by a majority of the Conservation Commission. On this 1 tSelL day of r 19 gr g before me personally appeared -Ar- a , to me known to be the person described in, and who executed. the foregoing instrument, and acknowledged that hershe executed thewes his/her traa��cct and e 7 zf ,( ". N,l 2 9% 2ct7 � Nowt' putAc My commission expires TM Dammslw don not fakers fro appww "m t drna ng w+th as 0war 0001101a lsdsrd. anlr Or fo0a1 atatutaa, ordINMOCaa, by4wa w regum e. Tfia DaMmr+uM Vag of Waled for tfrss Y"s tam 1te am of sivarru. TM aPplaara. ttrs owrraG any Paaon appread 0Y patsmanauon. anY rrmsr a land aouoap tte land upon whcn tfe 0rdpossd wank lsa a aae, a any rsn rssiosraa a tr» ay Drawn In when suer Irma a WAM. an nerady rowed at mw rgnt to drown me Dsparuosm a Eumdr waaf pros m a maw a Supwasdbq Dswraim twn of Appi"t-RAY. PADvdvq we Musa IS Ids" by 0 WWO marl Or nand 000 - I a fro ospoWent, wan the &foMpnw faing I" and Fes TrarranitW Form as Prowdad in i10 CUR 10.0 M warn Wn am" from wn CM of Jaimoa of frig Dnam*ubM A dopy a tns fwwn SW at fro lama Was 10 dart DY nnifed red or two dalw" a ue Cwesnavan Coarenwn and tM appkcam. 2.2A PLOT PLAN Abuttor I s Name Lot # If this is a corner lot, write in name of street. w b R FOR LOT # ?4 Indicate location of garage or accessory building Additions with dashed lines • -------------------- Sewerage disposal (cesspool) CD Well gr I I (lot................ft. rear) I SIDE YARD Q REAR YARD ........1....ft. HOUSE SET BACK SIDE YARD 0-----FTO (lot..................ft. frontage) i/c) \ / (NAME OF STREET) / Information / \ \ Supplied by MARK NORTH POINT a b Hi 1 Abuttor I s Name Lot #�/ If this is corner lo- write in name of other street. I 15 FIR; 1%6 N., ro mule 67 7�0 ck:�, w kv, Z, nyvy el ,qrsoir &.x v ;�v r4 1DOI-1 fi ;41-,D?,dr- 46 9 Suggested Affidavit for Home Improvement Contractor Permit Application For Ofnce Use Only Permtl No. Date NAME OF CITY/TOWN AFFIDAVIT Home Improvement Contractor Law Supplemetit to Permit Application MGLe.14ZArequires that the •reconstruction,alteration, renovation, repair, modernization,conversion, inyrovement.removal, demolition, or construction of an addition to any orectistint owneroccuyied buildine containint at least one but not more than rourdwellint units .... or to structures which are adjacent to such residence or building be done by registered contractors, with certain erceplious, along with other requirements f%P yaNC17 £-X�1tS/ZC /7oDM co Type of Work: o7o7Jit�� 2�4�' /i✓fi�ir/4 BAse�Pn�EsL C� D Address of Owner Name: �A01JWeA."(1C Melee l/ " O60A/X/D%? Date of Permit Application: ,%O /,41 I hereby certify that: Registration is not required for the following rcason(s): _Work excluded by law BJob under S1,000 uilding not owncr-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: 1 hereby apply for a permit as the agent of the owner: Da Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name /PLEASE PRINT: JOB LOCATION OWNER OF PRO; BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM CONSTRUCTION SUPERVISOR: ADDRESS: LICENSED DESIGNEE: (IF OTHER. THAN SUPERVISOR) NAME LICENSE NO. 2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: 2.15.1 THE LICENSE HOLDER SHALL. BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE IS SUPERVISING. HE.SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE BUILDING CODE AND THE DRAWINGS AS APPROVED BY THE BUILDING OFFICIAL 2.15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION, ALTERATION, REPAIR, REMOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE COMMONWEALTH,. EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB— CONTRACTOR'OR CONTRACTOR TO THE PERMIT HOLDER. 2.15.3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE DISCOVERY OF ANY VIOLATIONS WHICH ARE COVERED BY THE BUILDING PERMIT. 2.15.4 ANY LICENSEE WHO SHALL WILLFULLY VIOLATE SUBSECTIONS 2.15.1, 2.15.2 OR 2.15.3 OR ANY OTHER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL BE SUBJECT TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. 2.16. ALL BUILDING PERMIT APPLICATIONS SHALL CONTAIN THE NAME, SIGNATURE AND LICENSE NUMBER OF THE CONSTRUCTION SUPERVISOR WHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECON- STRUCTION, ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.1 OF THE CODE AND THESE RULES AND REGLZATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISING SAID PERSONS, THE WORK SHALL L121EDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPARTMENT. I HAVE.READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND.REGULATIONS FOR LICENSING CON- STRUCTION SUPERVISORS 11 ACCORDANCE ;:ITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTh;i: THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. INSURANCE CO ERAGE: I have a curren fabtlity insurance policy or its substantial equivalent which meets the requirements of MGL �Ch.152 Yes No ❑ If you have checked ves, please indicate the type c average by checking the ap;rcpriate box. A liability insurance pc!icy ❑ O:her type of :ndemnity ❑ t3ond ❑ OWNER'S INSURANCE WAIVER: I am aware that the ucensee does not have the insurance coverage. required ty WC.h3a2 of t e ass:G eral Laws. ano Mat my signature on t.`.:s permit .cpliczticn wanes this requiremem- Check one:/Owner) Agent 2",.ner or Owner 0tent SIGNATURE: BUILDING OFFICIAL APPROVAL: The Commonwealth of Massachusetts Department of Industrial Accidents oxceelloresl/pstliis 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit • •liczT t-I nfo rTr . • i Jfil rri'1151 cit.. , phone 0 1 am a homeowner performing all work myself. © I am a sole proprietor and have no one %%orkine in any capacity O lam an employer pro%iding workers' compensation for my employees working on this job. insurance co policy # ❑ I am a sole proprietor. _eneral contractor, or homeowner (circle one) and have hired the contractors listed below %%ho ha%e the following %%orkers' compensation polices: Failure to secure coversge as required under Section 2SA of MGL 152 tan lead to the Imposition of criminal peuities of aline up to SIAN.00 and/or one years' Imprisonment as well as civil penalties is the form of a STOP WORK ORDER and a rise of S100.00 a day against me. I sadershad that ■ copy of this statement maybe forwarded to the Office of lovestigstions of the DIA for coverage verifiadon. I do hereby cord nde► a pains and penalties of perfury that the information provided above is true and coned Signature ate �z9/�z Print name-.�•J�r/1A77s� GAZIV-eda f2, PhoneI �7�Q `aOl T I fficial use only do not write in this area to be completed by city or town official city or town: YARI!5011'1'11 ❑ check if immediate response is required contact person: permlUlicense 0 nBuildiog Department ❑Ucensiog Board 261 ❑Selectmen's Once ❑Health Department phone#;_ (508) 398-2231 ext. nothcr Ir"ned Los P)At Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An enrph�t•er 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 d%%ellina house of another who employs persons to do maintenance ; construction or repair work on such dwelling house or on the :rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. NIGL chapter I S_ -section _5 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. neither the commomvealth 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 supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy. please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents flllce If Illrlles"11"INS 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 BUILDING-P�E-RMIT APPLICATION SIGN OFF APPLICANT: /�irt/Al2 t� �<jZA1PAe) JJ lZ BUILDING PERMIT #: /�// ADDRESS: n!.C1WOOD<1j)e� 2el1 1-ai4J2A ELE. NO.: �0 F- 2'67 DATE FILED: /Q�/- BLDG. SITE LOCATION: •���/ C�'Z��gT SG�4.t/D %� MAP#: LOT#: _'_Tz �j TT 0 Ive ! THE FOLLOWING INFORMATION OUTLINES THE PROCEDURAL STEPS REQUIRED TO OBTAIN A PERMIT TO BUILD, ALTER, OR ADD TO A STRUCTURE WITHIN THE TOWN OF YARMOUTH. THE BUILDING DEPARTMENT WILL DETER- MINE COMPLIANCE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APPLICANT THOUGH THE FOLLOWING DEPARTMENTS: WATER DEPARTMENT: ENGINEERING DEPARTMENT: CONSERVATION COMMISSION: HEALTH DEPARTMENT: FIRE DEPARTMENT: RESIDENTIAL AND/OR COMMERCIAL BUILDING DETERMINES COMPLIANCE OF WATER AVAILABILITY. DETERMINES COMPLIANCE FOR PARKING AND DRAINAGE. DETERMINES COMPLIANCE TO WETLANDS ACTS, I.E.: IF LOT(S) BORDER ANY TYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS, MARSH LAND, ETC. DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E.: REQUIRE- MENTS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES. DETERMINES COMPLIANCE TO STATE AND TOWN REQUIREMENTS FOR PERSONAL SAFETY, PROPERTY PROTECTION, I.E., SMOKE DETECTORS, SPRINKLER SYSTEMS, ETC. THE FOLLOWING DEPARTMENTS MUST SIGN OFF, ISSUING THE REQUIRED BUILDING PERMIT: REVIEWED BY: \1. WATER DEPARTMENT 2. ENGINEERING DEI R \3. CONSERVATION: 4. HEALTH DEPARTMENT / ._ e fh A IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR DATE: N/A: DATE: N/A: DATE: DATE: Ap—[G N/A: COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE ALL STUMPS AND/OR BRUSH MUST BE DISPOSED OF AT AN APPROVED SITE. A SIGNED RECEIPT FROM THE DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING PERMIT. /� �,� COMMENTS: /f/YAUtI.;. .,eT/ /il►I.!/Lci�. /YiiCeJ .t� .t.I.�Cltc/uo_ ��/i1�/.� �,/X?�7� tl rlr�. BLM 89 TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 Date : April 41 2000 Name : LAWRENCE O'CONNOR Legal Address : 369 GREAT ISLAND ROAD : WEST YARMOUTH, MA 02673 Service Address : 369A GREAV ISLAND ROAD : WEST YARMOUTH, MA 02673 Assessor's Sheet # : 14 Certified Mail # : Z 483 195 057 New Structure : X Existing Structure NOTICE Service # : 13980 Lots) # : 82 This is to advise you that the Town of Yarmouth Water Department 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. Town of Yarmouth Water Department regulations prohibit the use of this water service as a grounding device for your electrical service. It is recommended that you contact an electrical contractor to ensure that your electrical service grounding is in compliance with Massachusetts Electrical Code, CMR, S27-12.00 Article 250. A copy of this notice is being forwarded to the Town of Yarmouth Wiring Inspector. %icftat-dA row ey Superint dent cc Wiring Inspector File Use Only r. The Commonwealth of Massachusetts EO:rtcr Ub_� �� ratt So. . = Department of Public Safety Occupancy L Fee Checked BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1100 3/90 Uea.e stank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AH Work to be performed In accordance With the Massachusetts Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN nm OR TUE ALL INFORHM931) Date LL bo 1010 City or Town of U To the Inspee tor— f Wires: The undersigned applies for a permit to perform the electrical work described Location (Street L Number) Jb 1 Owner or Tenant V�1 1 u_. I e_Axe Owner's Address Q \V•V UY Is this permit in conjunction �w,itth a bui`ldding permit: Yes No ❑ e Box) Purpose of Building `�C b; �i7(A6 . �Lm Utility Authorization NO. Existing Service 1OO Amps %ZO / 2yb Volts Overhead ❑ Undgrd [9"/ No. of Meters__ New Service Amps / Volts Overbead ❑ Undgrd ❑ No. of Meters, Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work av No. of Lighting Outlets 8 8 No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. o£ 011 Burners Baete£ EUnitsncy Lighting No. of Switch Outlets No. of Gas Burners 1 FIRE ALARMS No. of Zones No. of Detection and al Itons No. of Ranges No. of Air Cond. Initiating Devices No. of Sounding Devices No. of Disposals No. of HPum)s TOtn3 To�l No. of Local ❑ icial CConnection❑ Other No. of Dishwashers Space/Area Heating XW No. of Dryers Heating Devices KW No. of Water Heaters KW No, of o. o Si ns Ballasts Low Voltage Wiring No. Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE- Pursuant to the requirements of Massachusetts General Laws 10.1 I have a current ilit Insurance Policy including Completed Operations Coverage or t ubstantial equivalent. YES NO I have submitted valid proof of same to this office. YES NO ❑ If you have checkche!kpd YESr please indicate the type of coverage by checking the appropriate box. INSURANCE OND ❑ OTHER ❑ (Please Specify) Expiration ate Estimated Value of E ect ical Work S Work to Start 00 Inspection Dace Requested: Rough 51llR t!,�Final Signed under the penalties of perjury: 1� l FIRM NAME L CO l 11LC r LIC. NO'B 1 \9,S l Signature\U1oo)1 tic. No. nuts. aaa -11 1- — — Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) . Telephone No. PERMII FEE S Signature of Owner or Agent MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING — (Print or Type) Do'.1wol TOWN OF A)J!?67- Y1W,1177d0H1 Date 1�Permit# 0-4D//��! . Buliding Location i 5, Owner's Name Type of Occupancy res iz)zw E New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ r4 MEN SONi �o�oou inn ON & Io �oo� momo �m Installing Company Name CAR TEDFL -1 5[ul Check one: Certificate Address IT? M A w ST ❑ Corporation — 8,4516-RVILL-K MA WL55' ❑ Partnership Business Telephone 47-g- G AinS ❑ Firm/Co. Name of Ucensed Plumber or Gas Fitter INSURANCE COVERAGE: have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked ygg, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issue for this applica'on will be in compliance with all Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the GenevfLawif r0ty/Town_ T e of Ucense: ��Plumber gna urs o tense lumber or as Ater e Master 2agCQ Maslen Ucense Number BJournovm v n� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) ,� TOWN OF W4e.& �_ yb P -`GXJDae e0 Pcrmit.#k D c /-�I Building Location Ggea Owner's Name �L pOIV� )a �S Type of Occupancy � s + New ❑ Renovation 11Y Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES E0117r. ME Installing Company Name CeaL &CDv;u , ��CCheck one: Certificate Address__ %'7Q• A411,/ sr L'f'Corporation (>;Z2�9 V L L F M A ❑ Partnership Business Telephone_ x/R.Q-(. 31,,,❑Firm/Co. Name o! Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbi Code a Chapter 144, a the Gnnerraal%ws. BY Title Signature of Ucensed Plumber ,'1 rall Type of License: Master ❑ Journeyman ❑ APPROVED ( FFIC USE NLY) license Number Fyoow3. PA I -I A PR 1 2 2000 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK NI work to be performed in accordance with the Massachusetts Electrical Code, (RIEC), 527 CDIR 12.00 TOWN OF ! RMOff MAY so1111 D g� 5' � 3a� (PLEASE PRINT IN INK OR TYPE ALL (OFFICE USE ONLY) L L. Fee:$ 30,0D PERMIT NO. C-0/" 7 Q j8 Date: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention work described below. qq /� Q Location (Street 4: Number)y�_` tORLA'ti �S j `f�ih� �y t Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? 9Kes QNo (Check Appropriate Box) 'Zq l o perform the electrical 0 1\ Purpose of Building' GggSOo 2 Vn Utility Authorization No. . Existing Servicel Oo Amps V 2Q / lq'c Volts Overhead[] Undgrd 93' No. of Meters -New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters 4 Number of Feeders and Ampacity I Location and Nature of Proposed electrical Work: r'nn,nlvtinn of the r illmrin a mhlr mau he n•ni vrd by the In rnrrtnr of (firer 0 o Recessed Fixtures i -Sus a Ie • is No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above n- Swimming Pool rnd. ❑ "rnd. Q No. of Emergency Lighting Battcry Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o Detection an InitiatingDevices No. of Ranges Tote No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat amp Totals: um er — Tons _ _ No. of Self -Contained Detect ion/Alertin No. of Dishwashers Space/Area Heating KW Local ❑ No. of Dryers Heating Appliances KW e pp Security Systems: No. of Device. . ui valent No. of Water Heaters KW No. of No. of Si ns Ballasts Data wiring: No. of Device. Jd uiva ent No. Hydromassagc Bathtubs No. of Motors Total HP Telccommunicatit ns Wiring: No. of Dcvicc, ® F uivalent 0 Attach additional detail if desired. or as required by the Inspector of hires. �NSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides V� 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:) 'tEstimaled Value of d'Work to Start 4zJ1 certify, underA�he FIRM NAME:}, (Expiration Dale) (When required by municipal policy.) nspcctions to be requested in accordance with MEC Rule 10, and upon completion. cs of perjury, that the information on this application is true and complete. L G V L t C- LIC. NO. LI C d Signature LIC. NO. 7 (If applicable, eV�jr� "exempt" in the license nunibc55 ine.) Bus. Tel. No.:�4,'Z`^� q� Address. 2 0 W ✓ S� �ArLrloll �� p�rL�F'M � oL6),5 AI[. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nut have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner Q Owner/Agent Signature _ IRev. 04/00J owner's agent. it Telephone No. 612412015 SlipGen- Portal Hone Town of Yarmouth ' Template [Building Dept] ■ Slipsheet Identifier [sg28876] Document Category Building Permits Map -Block Number 014.1 Street Number 0369 Street Name GREAT ISLAND RD Department Building Parcel ID 94 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2015-06-24 - 09:31 ftWAaser<iche121SlipGed v1