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HomeMy WebLinkAboutBuilding PermitsFILED WITH TOWN CLERK: PETITION NO. #4580 Bk 28852 P9282 .;20256 05-08-2015 & 1O-17m TOWN OF YARMOUTH BOARD OF APPEALS DECISION March 30, 2015 HEARING DATE: March 12, 2015 PETITIONER: Town of Yarmouth, Parks and Recreation PROPERTY: 31 Dupont Avenue, South Yarmouth Map and Lot #:0100.1; Zoning District: R40 Book & Page: 4738/242 MEMBERS PRESENT AND VOTING: Steven DeYoung, Chairman, Sean Igoe, Bryant Palmer and Richard Neitz. It appearing that notice of said hearing has been given by sending notice thereof to the Petitioner and all those owners of property deemed by the Board to be affected thereby, and to the public by posting notice of the hearing and published in The Register, the hearing was opened and held on the date stated above. The Petitioner, the Town of Yarmouth, was well -represented by Pat Armstrong, Parks and Recreation Director. The Petition seeks a Variance under By-law §202.5, Use Table N3 to permit theatrical productions, bands, orchestras and entertainment inclusive of outdoor entertainment at its facility located in the Flax Pond Recreation Area, 31 Dupont Avenue, South Yarmouth, property in an R-40 Zoning District. Each Board member expressed concerns over noise affecting the immediate, abutting residential area. During the hearing, no exhibits were received. No one spoke in opposition to the requested relief. The Board considered the requested zoning relief only. Clearly, it is the Board of Selectmen that will decide as, if and when entertainment licenses are required. However, the Board was unanimous in its belief that the grant of the relief could be considered as 1) literal enforcement of the By-law regarding Use Table designation N-3 would create an substantial hardship (economic) upon the Town by loss of the prospective revenues; 2) the hardship relates to the shape, location and topography of the land, in that the facility is located immediately adjacent to a pond while otherwise surrounded by woodland; and 3) the relief can be granted, with conditions without creation of any detriment to the public good nor nullification nor substantial derogation from the purpose and intent of the By-laws. Mr. Palmer then made a Motion, seconded by Mr. Neitz, to approve the requested relief. The Board considered the Motion and voted unanimously in favor of it upon the following conditions: 1) Hours of entertainment be limited to 9:00 A.M. to 9:00 P.M. inside the building and from 9:00 A.M. to 7:00 P.M. outside the building; 2) The Petitioner present the matter for a review in one year and be required to furnish the Board any noise complaints relating to use of the building; 3) If 40 or more attendees are anticipated, a Recreational Staff person must be in attendance. If more than 80 attendees are anticipated, two Recreational Staff persons must be in attendance; and If 40 or more attendees are anticipated at any event where alcohol is to be served, a police detail is required. 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 MGL c40A section 17 and must be filed within 20 days after filing of this noticeldecision with the Town Clerk. Unless otherwise provided herein, a Variance shall lapse if the rights authorized herein are not excised within 12 months. (See MGL c40A § 10) Steven DeYoung, CRadman PA THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF APPEALS Appeal # 4580 Date: April 21, 2015 Certificate of Granting of Variance (General Laws Chapter 40A, Section 11) The Board of Appeals of the Town of Yarmouth Massachusetts hereby certifies that a Variance has been granted to: Town of Yarmouth, Parks and Recreation 424 Route 28 Nest Yarmouth, MA 02673 Affecting the rights of the owner with respect to land or buildings at 31 Dupont Avenue, Nest Yarmouth, MA; Zoning District: R40; Map & Lot#: 0100.1; Book/Page: 4738/242 and the said Board of Appeals further certifies that the decision attached hereto is a true and correct copy of its decision granting said Special Permit and Variance, and that copies of said decision, and of all plans referred to in the decision, have been filed. The Board of Appeals also calls to the attention of the owner or applicant that General Laws, Chapter 40A, Section 11 (last paragraph) provides that no Variance, or any extension, modification or renewal thereof, shall take effect until a copy of the decision bearing the certification of the Town Clerk that twenty days (20) have elapsed after the decision has been filed in the office of the Town Clerk and no appeal has been filed or that, if such appeal has been filed, that it has been dismissed or denied, is recorded in the Registry of Deeds for the county and district in which the land is located and indexed in the grantor index under the name of the owner of record or is recorded and noted on the owner's certificate of title. The fee for such recording or registering shall be paid by the owner or applicant. .� �� Steven DeYoung, 'rman TOWN OF YARMOUTH Town = 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-4451 Clerk Telephone (508) 398-2231 Ext. 1285, Fax (508) 398-0836 CERTIFICATION OF TOWN CLERK I, Philip B. Gaudet, III, Town Clerk, Town of Yarmouth, do hereby certify that 20 days have elapsed since the filing with me of the above Board of Appeals Decision 04580 that no notice of Vial of said decision has been filed with me, or, if such appeal has been filed it has been r''tii*is3ed or denied. All appeals have been exhausted. Philip B. Gaudet, III Town Clerk BAUSTABLE REGISTRY OF DEEDS John F. Meade, Register t 00 r TOWN OF YARMOUTH Building Department _ • S (508) 398-2231 ext.1261 PERMIT NO B-14-1614_' +. ISSUE DATE 5�30/Y0j4 ,PROPOSED USE.. -CP APPLICANT ,Thomaslydng -- ----- AT (LOCATION) 10031 DUPONT AVE .ZONING DISTRI R� SUBDIVISION MAP LOT BLOCK 1100.1 ? - BUILDING IS TO BE: CONST r LOT SIZE E REMARKS 18 x 24 concrete pad for proposed shade structure as per plans dated 05129/14. i AREA (SO FT) EST COST ($ $12,SOO.DO PERMIT FEE ($) OWNER rOWN OF YARMOUTH /Flax Pond BUILDING DEPT BY ADDRESS 1148 Route 28 South YannouM I MA 102&9 INSPECTION RECORD Date Note Progress - Corrections and s Foundation Location Arproved BUILDING PERMIT 313 WEATHER CARD PERMITTO ' MisoJfoundation' Bldg. Type: Commercial 'EO USE GROUPC CONTRACTOR LICENSE 14439 275 Valley street Pembroke MA 02359 7818314938 PHONE 15083982231 FIELD COPY 4 s So*'04 TOWN OF YARMOUtH Building Department(7 BUILDING (508) 398-2231 PERMffNO B-1416]2_' PERMIT �am)ISSUE DATE ; _ Si30/2014 _ ; PROPOSED USE APPLICANT .Thomas IWrg .r, - - - - - - - - JOB WEATHER CARD PERMITTO ; Misc.Roundation ; AT (LOCATION) 100310UPONTAVE ZONING DISTRICTRd0 Bldg. Type: Commerclal SUBDIVISION MAP LOT BLOCK 1100.1 771 BUILDING IS TO BE: CONST TYPE USE LOT SIZE construct 16 x 24 slab as per plans dated 05r29/14. REMARKS AREA (SO FT) EST COST ($ 512 OWNER OWN OF YARMOUTW Flax Pond ADDRESS 1148 Route 28 SoUth Yarmouth I MA 102664 PERMIT FEE ($) t60.00 BUILDING DEPT BY CONTRACTOR LICENSE 014439 IMng,Thomas 275 Valley Street Pembroke MA 02359 7818314938 PHONE 15083982231 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector 4,- a :':uadc:ion Location Arnrnvpd i.!/ is a TOWN OFYARMO&H Building Department BUILDING i _ (508) 398-223 PERMIT T B_14,5n_. ..__ PERMIT ISSUE DATE ;_ 5/12R014 _ : PROPOSED USE APPLICANT Ttomaslrvirq -- JOB WEATHER CARD ............ PERMITTO %tccessoryStructure I AT (LOCATION) 0031DUPONT AVE ZONING DISTRICTR40 Bldg. Type: Commercial I SUBDIVISION MAP LOT BLOCK 1100.1 1 BUILDING IS TO BE: CONST TYPE" USE LOT SIZE E construct a shade structure as per plans dated 0&12/14. REMARKS AREA (SO FT) EST COST ($ 5,000.00 PERMIT FEE ($) OWNER OWN OF YARMOUTH /FLAX POND BUILDING DEPT BY ADDRESS 1148 ROUI0 28 South Yarmouth I MA 102664 INSPECTION RECORD CONTRACTOR LICENSE 014439 Irving, Thomas 1 Liberty Street Hanson MA 02341 3399338919 PHONE 15083982231 FIELD COPY Date Note Progress - Corrections and Remarks Inspector Sao z3 .,�- .. or a TOWN OF YARMOUTH Building Department BUILDING (508) 398- a 261 PERMIT NO 6-141521 _ PERMIT r. ISSUE DATE ; _ 5/13/2014 _ ; PROPOSED US (D- ........ PERMIT APPLICANT :ThomesGvinO'""'''"'-"---- JOB WEATHER CARD PERMITTO Al cessoryStructure I AT (LOCATION 10031DUPONTAVE ZONING DISTRICTEE Bldg. Type: Commercial I SUBDIVISION MAP LOT BLOCK 1100.1 BUILDING IS TO BE: LOT SIZE construct gazebo at Flax Pond as per plans dated 05t12t14. REMARKS AREA (SO FT) EST COST ($ 545,000.00 PERMIT FEE ($) OWNER ITOWN OFYARMOUTH/FLAXOPND BUILDING DEPT BY ADDRESS 11146ROU1928 South Yarmouth I MA 102664 INSPECTION RECORD USE GROUP CONTRACTOR LICENSE 014439 vIng, Thomas 1 Liberty Street Hanson MA 02341 3399338919 PHONE 15083982231 FIELD COPY Date Note Progress - Corrections and Remarks Inspector S— T t — i ti` eff v P01,189off May 23, 2014 Dandel Construction 1 Liberty Street Henson, MA 02341 Attn: Tom Irving Re: Flax Pond (poligon Job #51753/51754) Horizontal Ties in Foundations Mr. Irving, This letter is to address the deviation from the sealed Poligon drawings. The details shown on Sheet 2.1 indicate #4 horizontal ties in the drilled pier foundation at twelve (12) inches center to center with two (2) ties in the top five (5) inches of the foundation. It is my understanding that #3 ties were substituted and spaced six (6) inches center to center, deviating from the drawings. After reviewing the design, the use of 93 ties six (6) inches center to center is acceptable provided three (3) ties are placed in the top five (5) inches of the foundation. Should you have any questions, or require anything further, please feel free to contact me at your convenience at 616.399.1963 ext. 420 or chreva@portereorp.com. Sincerely, Chris Evans, P.E. Professional Engineer www.poligon.com • P. 616-399-1963 • F. 616-399-9123 • 4240 N 136thAve, Holland M149424 -3) buPoA17 t116�' TOWN OF YARMO= BFILE COPY PARKS and RECREATION DMSION 424 Route 28, West Yarmouth, MA. 02673 Telephone (508) 398-2231 ext 1520 Fax (508) 790-9152 Email: Parksandrecreation(cDVarmouth.ma.us Director Assistant Recreation Director Patricia Pvt Armstrong, CPRP Mary C. Franklin rarmstrona�yarmouth.ma.us mfranklinnvarmouth.ma.us TO: The Zoning Board of Appeals CC: Sandy Clark, Board of Appeals POA Mark Grylls, Building Commissioner Peter Johnson -Staub, Assistant Town Admini FR. Patricia M. Armstrong, Director of Parks and RE: Request for Variance for Flax Pond recreatior DT: January30, 2015 Acting Park Supervisor David E. Carlson dcarlson(a)varmouth.ma.us The Flax Pond Recreation Area has recently been upgraded to include a year-round building that can be utilized for public events, private functions and seasonal programming. We anticipate requests for amplified entertainment outside of the main building as well as partnerships with the Cultural Center of Cape Cod, Cotuit Center for the Arts and other regional non-profit cultural organizations. We are also beginning toe receive request to use the facilities for weddings and other celebrations that will include live and recorded music. These new anticipated uses are presently not permitted under the N-9 Municipal Recreation existing zoning classification. The Town would like to add an N-3 Theatrical Productions, Bands and Entertainers variance for the active recreation parcel of 16+ acres in the center of the property. This will provide for a significant buffer from abutters and maintain a control area for functions. If approved, we will then go before the Board of Selectmen for a blanket Entertainment License for the facility. This way we can manage the activities of our renters with careful consideration given to the existing zoning codes and any conditions attached to our permits. I I have spoken to Mr. Grylls and Mr. Brandolini and both concur that this is the recommended zoning for this property. I would like to extend an offer to the board to view the property before the hearing so that you can get a feel for the layout and actual conditions. I would be happy to schedule two viewings so the Board is in compliance with Open Meeting Laws. �i 00*Q (7 TOWN OF YARMOUTH Building Department0 BUILDING__.(508)398-2231 ext.1261 PERMR NO B-141497. ISSUE DATE :..5=.0-14_ _ ; PROPOSED USE : ; PERMIT APPLICANT Patricia Armstrong JOB WEATHER CARD PERMITTO Accessory Structure' AT(LOCATION) 10031DUPONTAVE I ZONING DISTRI R-40 SUBDIVISION MAP LOT BLOCK 1100.1 BUILDING IS TO BE: CONST 1 LOT SIZE set two temporary classrooms an Flax Pond Site -June 15 -Sept 14, 2014 REMARKS AREA (SO FT) EST COST ($ j32,5W.00 PERMIT FEE ($) OWNER OWN OF YARMOUTH/Recreation BUILDING DEPT BY ADDRESS 111478ROute28 South Yarmouth I MA 102664 INSPECTION RECORD Date Note Proaress - Corrections and Bldg. Type: Commerdel 'E= USEGROUPF— CONTRACTOR LICENSE 0 PHONE 150839SM1 FIELD COPY TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, D1A 02664 508-398-2231 ext.1261 COMMUNITY EVENT SIGN APPLICATION 0,041 Application is hereby made to install a Community Event Sign, in accordance with MGL Sect 8, Chap. 85, and Town of Yarmouth Zoning Bylaw Section 303.4.1.1 (except for maximum duration), and the Selectinen's Community Event Sign Policy. An application may be submitted by religious, civic and non-profit organizations. Construction and installation of signs shall be the sole responsibility of the applicant Signs must be approved by the Yarmouth Building Department The locations must also be approved by the Yarmouth Department of Public Works. Signs on town land must be approved by the Town Administrator. Signs on private land must be approved by the property owner. There is no fee for Community Event Signs. This application shall be accompanied by a diagram showing the design, dimensions, colors, and proposed location for the sign. Additional regulations: Z?a4n� f ( fX3 The size of signs is limited to thirty-two (32) square feet If the sign is double-faced, only one side will be counted for measurement Signs Installed and permitted under this policy may be installed for up to 12 months duration, or until the advertised event or campaign is completed, whichever comes first Renewals may be applied for through the Building Department The content of signs must be non -political and for a non-profit organization. Internal Illumination, moving parts, or the appearance of moving parts is prohibited. The applicants agree to abide by the terms of these laws egu�ti ns. Community Event sig units may be revoked at any time for any infraction of these laws and regulations. 3,yo�,t,T APPLICANT: 6-heas Y� ��e Permits S�•�'Od /Li SIGN LOCATION: F76Tc Ar-C' fRfrancq- - fanla OJT-4-. CONTACTPERSON: 0"OLe )helps MAILADDRESS:10 BIUe Rto!<i. gco 'lm ail INSTALLATION & REMOVAL DATES: SIGNATURE OF CONTACTIAUTHORIZED Please Note: The Building Department APPLICATION APPROVED BY: APPLICATION APPROVED BY: APPLICATION APPROVED BY: IJ A 4-IM =1� [a)t4111t:L4 PHONE46W) 05- %SS,S EMAIL: cghe2�yb�SheetS � uate Of any change in the above Information. APPLICANT SIGNATURE: Date �2ryia;/ elh%s L cf- 92"7 §�Mkly IFOIR SI IEr')J I's TOWN OF YARMOUTH pupa"-[ BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ez[1261131 COMMUNITY EVENT SIGN APPLICATION Application is hereby made to Install a Community Event Sign, in accordance with MGL Sect 8, Chap. 85, and Town of Yarmouth Zoning Bylaw Section 303.4.1.1 (except for maximum duration), and the Selectmen's Community Event Sign Policy. An application may be submitted by religious, civic and non-profit organizations. Construction and Installation of signs shall be the sole responsibility of the applicant Signs must be approved by the Yarmouth Building Department The locations must also be approved by the Yarmouth Department of Public Works. Signs on town land must be approved by the Town Administrator. Signs on private land must be approved by the property owner. There is no fee for Community Event Signs. This application shalt be accompanied by a diagram showing the design, dimensions, colors, and proposed location for the sign. Additional regulations: The size of signs is limited to thirty-two (32) square feet If the sign is double-faced, only one side will be counted for measurement Signs installed and permitted under this policy may be Installed for up to 12 months duration, or until the advertised event or campaign is completed, whichever comes first Renewals may be applied for through the Building Department The content of signs must be non -political and for a non-profit organization. Internal Illumination, moving parts, or the appearance of moving parts is prohibited. The applicants agree to abide by the terms of these laws and regulations. Community Event sign permits may be revoked at any time for any infraction of these laws and regulations. APPLICANT: SIGN LOCATION: F70K 190r,�:4 Er-rfrGLnm 4 ' 6ntO OJM42 CONTACT PERSON: 0"0Ler�, MAILADDRESS:10 INSTALLATION 3 REMOVAL DATES: �}tlgUS� 2 SIGNATURE OF CONTACT/AUTHORIZED GGENT: e I Permit i PHONE: EMAIL• gheasy�ShM5 11DCl�rhit . i-0!if 713/ Please Note: The Building Department shall be notified within ten (10) days of any change In the above Information. APPLICATION APPROVED BY: APPLICATION APPROVED BY: APPLICATION APPROVED for PLEASE NOTE THE L Amault, BuilgoglSign Inspector Date APPLICANT SIGNATURE: Date a r TOWN OF YARMOUTH Building Department BUILDING -- •- „ (508)398-2231 exL1261 _ PERMIT NO - B-1g-458 . PROPOSED USE PERMIT �. ISSUE DATE ;- 9/26/2013 ; ....... APPLICANT Damon Bunill • • • • • - • • JOB WEATHER CARD --- - - -on ; IAT (LOCATION) 10031DUPONTAVE I ZONING DISTRI R-40 Bldg. Type: Commercial I SUBDIVISION MAP LOT BLOCK 1100.1 1 BUILDING IS TO BE: CONST TYPE 5-B USE GROUPFA-4-1 LOT SIZE construct new restroom addttion to Flax Pond Lodge Bldg. REMARKS AREA (SO FT) EST COST ($ $644,975.00 PERMIT FEE ($) OWNER IFLAX POND RECREATION 9X7 Y ADDRESS 1148 Route 28 South Yarmouth MA 0266.4 CONTRACTOR LICENSE 068304 Burchill, Damon P. O. Box 1539 Harwich MA 02645 5084320530 PHONE 15083982231 Certificate Issue Date f CERTIFICATE of OCCUPANCY Departmental Approval for Certificate of Occupancy and Compliance BUILDING PLUMBING/GAS ELECTRICAL ENGINEERING HEALTH FIRE WATER OLD KINGS Date Permit Number To be filled in by each division indicated hereon upon completion of its final Inspectlon. a r TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.1261 ' PERMIT NO .__B-;�59_, ________ PERMIT ISSUE DATE 9/2612013 • ; PROPOSED USE APPLICANT 'Daman 6uroh0i • - • • • - • - • -- • • - ` • JOB WEATHER CARD PERMRTO pccessoryShucmre IAT (LOCATION) 0031DUPONT AVE I ZONING DISTRICTEE Bldg. Type: Commercial I SUBDIVISION MAP LOT BLOCK 1100.1 1 BUILDING IS TO BE: CONST TYPE USE GROUP LOT SIZE construct wood frame utility building for septic control equipment as per plans submitted. REMARKS AREA (SO FT) EST COST ($ 1$644.975.00 PERMIT FEE ($) 1$0.00 OWNER FTOWN OFYARMOUTH CONTRACTOR LICENSE 088304 P.O. Box 153=4 Great Waste - OA Harwich MA 02645 7748360993 ItDING DEPT BY ADDRESS j1146Routa28 South Yarmouth MA 02664 PHONE 5083982231 Certificate Issue Date CERTIFICATE of OCCUPANCY Departmental Approval for Certificate of Occupancy and Compliance Inspector Date Permit Number Approved By Remarks BUILDING PLUMBING/GAS ELECTRICAL HEALTH FIRE WATER OLD KINGS To be filled In by each division indicated hereon upon completion of its final Inspection. < < - BROWN LINDQUIST FENUCCIO & RABER ARCHITECTS, INC. 30 April 2014 Mark Grylls, Building Commissioner Town of Yarmouth 1146 Route 28 South Yarmouth, MA 02664 RE: Final Letter of Construction Progress @ Substantial Completion Flax Pond Phase II — Restroom Wing Addition & New Septic Control Building Dear Mr. Grylls, Attached please find stamped "Construction Control Affidavits at Project Completion" for Architectural, MEP and Structural. Since our last construction progress report, we have been conducting job site meetings every other week to monitor work in progress and adherence to the construction documents. All work completed has been done in a good and workmanlike manner and in accordance with the construction documents By submitting this letter and attached final affidavits, I am certifying the readiness of the building for occupancy. If you require any additional information, please feel free to contact me at any time. Sincerely, Tim Sawye CC: Ken Bates (Town of Yarmouth) Pat Armstrong (Town of Yarmouth) Dick Court (Town of Yarmouth) Damon Burchill (RBO) Rick Fenuccio (BLF&R Architects, Inc.) 203 HALLOW SHEET SUITE A YARMOUHH =AAA 02675 PH 508-W-8M2 FAX 508-362-2828 Final Construction Control Document To be submitted at completion of construction by a Registered Design Professional for work per the a edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.4 Project Title: Restroom Addition to the Flax Pond Lodge Building Date:V30/2014 Permit No. Property Address: 31 Dupont Ave. S. Yarmouth, MA Project Check (x) one or both as applicable: X New construction X Existing Construction Project desorption: New addition to Flax Pond Lodge Building & New Se He SMem Control 1 I Timothy R Sawyer MA Registration Number. 50399 Expiration date: 8-31-2014 , am a regirrered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications conoerningr: Entire Project X Architectural Structural Fire Protection Electrical Other. Mechanical for the above named project. I certify that L or my designee, have performed the necessary professional services and was present at the construction site on a regular and periodic basis to determine that the work proceeded in accordance with the requirements of 780 CMR and the design documents prepared by me and approved as part of the building permit and that I or my designee: 1. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. .., AA.. Enter in the space to the right a "wet" or electronic signature and seal: ( K`Wb. S0399 Phone number. 508-362-8382 Email: Building Official Use Only Building Official Name: PermitNo.: Date: Note 1. Tndieue with an W project design plans, computations and specifications tlut you prgmvd or directly supervis d, If'othce h chosen, provide a description. Trial Version 10 09 2012 Final Construction Control Document To be submitted at completion of construction by a Registered Design Professional for work per the Herr Edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Proposed lodge Building at Flax Pond Recreational Area Phase 11 Date: April 14, 2014 Property Address: 383 North Main Street — South Yarmouth_ Massachusetts Project: Check (x) One or Both as Applicable: PC] New Construction [ ] Existing Construction Project Description: Addition to the Lodge building. L Steven A. Karmr, PE. MA Registration Number. 34989, Expiration Date: 0613OZ201 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning - Architectural [ ] Structural PQ Mechanical [ ] Fire Protection [ ] Electrical I ] Other. (Describe) for the above named project I, or my designee, have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information, and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the Building Permit and that I or my Designee: 1. Have reviewed, for conformance to this Code and the design concept, shop drawings, samples and other submittals by the Contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17. as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this Code. Nothing in this document relieves the Contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a "wer or electronic signature and seal: 17�TTT1;11�1.^,.TFfig - 'J • r EmaiL•akarar aneeriny.com Building Official Use Only Building Official Name. Permit No.: Due: Version 0611P13 Initial Construction Control Document To be submitted with the Building Permit Application by a Registered Design Professional for work per the 8 Edition of the Massachusetts State Building Code, 780 CMR, Section 107.62 Project Title: Prop9 edge Building�a Flax Pond Recreational Area Phase R Date: August 26.2013 Property Address: 383 North Main Street —South Yarmouth. Massachusetts Project: Check One or Both as Applicable: (X) New Construction ( ) Existing Construction Project Description: Addition to the Lodge building. 1, Marc R, Plante, PE. MA Registration Number. 38119 Expiration Date: 06130/2014am a Registered Design Professional, and hereby certify that I will prepare or directly supervised the preparation of all design phuts, computations and specifications concerning: [ ] Architectural [ J Structural [J Mechanical [ ] Fire Protection [JJ Electrical [ ] Other. [ for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this Code and the design concept, shop drawings, samples and other submittals by the Contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this Code. When required by the Building Official, I shall submit field/progress reports (see Item 3.) together with pertinent comments, in a form acceptable to the Building Official. Upon completion of the work, I shall submit to the Building Official a'Final Construction Cent Enter in the space to the right a "wet7 or electronic signature and seal: Phone Number. _(508) 230-0260 Email: nolanteaRberen0neerinaeom Building Official Use Only Building Official Name: Permit No.: Date: Final Construction Control Document To be submitted at completion of construction by a Registered Design Professional for work per the 8°i Edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: b=sed Lodge Building at Flax Pond Recreational Area Phase 11 Date: AWI 14, 2014 Property Address: 383 North Main Stint —South Yarmouth. Massachusetts Project: Check (x) One or Both as Applicable: [X] New Construction [ ] Existing Construction Project Description: Addition to the Lodge building. I, Steven A. Kramr, PB MA Registration Number. 34989. Expiration Date: 06Q0/20/am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: I ] Architectural [ ] Structural (I Mechanical (j Fire Protection [ ] Electrical [X] Other. Plumbing for the above named project. I, or my designee, have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information, and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the Building Permit and that I or my Designee: 1. Have reviewed, for conformance to this Code and the design concept, shop drawings, samples and other submittals by the Contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17. as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this Code. Nothing in this document relieves the Contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a "wet" or electronic signature and seal: Phone Number.19081230-0260 tuww NECHAM 91L _ Oft. rhea r :,W Building Official Use Only Building Official Name. Permfr No.: Date: Version 06 11 4t113 Final Construction Control Document To be submitted at completion of construction by a Registered Design Professional for work per the 8t° edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.4 Project Title: Lodge Building Phase 11 Flax Pond Recreation Area Date: April 22, 2014 Permit No. Property Address: 31 Dupont Avenue South Yarmouth, MA Project: Check (x) one or both as applicable: X New construction Existing Construction Project description: Restroom Wing and Chemical Storage Feed Building 1, Paul F. Kirby, MA Registration Number: 35313 Expiration date: August 30, 2013 , am a registered design professional, and hereby certify that I have �repared or directly supervised the preparation of all design plans, computations and specifications concerning : Entire Project Architectural XX Structural Fire Protection Electrical tither: Mechanical for the above named project. 1 certify that 1, or my designee, have performed the necessary professional services and was present at the construction site on a regular and periodic basis to determine that the work proceeded in accordance with the requirements of 780 CMR and the design documents prepared by me and approved as part of the building permit and that I or my designee: 1. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Have been present at intervals appropriate to the sta a of construction to become generally familiar with the progress and quality of the work and to determ' t as performed in a manner consistent with the construction documents and this code. PAULE z KIRBY Enter in the space to the right a "wet" or $ yTpuCTUtaAL electronic signature and seal: No.35313 IsTre 3/t1NALE /,1 /` I 12- �//t Phone number: 781305.9419 Email: pkirby@allenmajor.com Building Official Use Only BuildingOfTicialName: Permit No.: Date: Note 1. Indicate with an W project design plans, computations and specifications that you prepared or directly supervised. If 'other' is chosen, provide a description. TOWN OF YARMOUTH Building Department BUILDING ....-----• (508) 398-2231 ext.1261 (Fv�. ' PERMff N0 8-14300 - ... .. - PROPOSED USE . PERMIT ISSUE DATE :. 8/28/2013 .: APPLICANT :rowhi oFYHIkMbil rl- - - - - - - - - - - - - - JOB WEATHER CARD ------------ PERMITTO Demolish ' AT(LOCATION) 10031DUPONTAVE ZONINGDISTRI R40 Bldg. Type: Residen0al SUBDMSION MAP LOT BLOCK F100.1 BUILDING IS TO BE: CONST TYPE® USE GROUP RJ LOT SIZE DEMOLISH 2 OUTBUILDINGS REMARKS AREA (SO FT) EST COST ($ L OWNER OWN OF YARMOUTH ADDRESS IOMI DUPONT AVE —� SOUTH YARMOUTH I MA 102664 (P) PERMIT FEE ($) 50.00 BUILDING DEPT BY CONTRACTOR LICENSE Court. Richard 158Indian Trail Dennisport MA 5082942415 PHONE 15083982231 INSPECTION RECORD FIELD COPY Date Note Progress Corrections and Remarks Inspector i o. r TOWN OF YARMOUTH Building Department BUILDING _ - _ - - . - - - - , (508) 398-2231 ext.1261 PERMIT PERMIT NO B-14-969 - .� ISSUE DATE ;- 1/21R014 _ ; PROPOSED USE - _ - - - - - - APPLICANT :RlchardCourt-----------"------ JOB WEATHER CARD PERMRTO Demolish ' AT(LOCATION) 10031DUPONTAVE 1 ZONING DISTRICTEE BIdg.Type: Commercial SUBDIVISION MAP LOT BLOCK 1100.1 BUILDING ISTO BE: CONSTTYPEr--j USE GTUP= LOT SIZE L. . . j CONTRACTOR demolish e)dsdng outbuilding REMARKS CENSE P Court, Richard 58 Indian Trall AREA (SO FT) EST COST ($ 53,000.00 PERMIT FEE ($) SO.Oo ennisport MA 82842415 OWNER OW N OF YARMOUTH/Flax Pond BUILDING DEPT BY ADDRESS 1146 Route 28 South Yarmouth 64 MA 026PHONE 5082942415 INSPECTION RECORD FIELD COPY Date Note Frogress - Corrections and Remarks Inspector • • dike it never even happened.' fin & Wafer - cleanup & tbsto ion" Tom & Lisa Bolcom .ho SERVPRO' of The Mid and Outer Cape 508-778-7378 l•�• 4 �- +r nip I r o• r TOWN OF YARMOUTH Building Department (508) 398-2231 ext.1261 B LH L D I N G = PERMffNO ::4.1:: PERMIT APPLICANT ISSUE DATE ltr26f2Q�$ PROPOSED USE APPLICANT .'Damon Burchill - - JOB WEATHER CARD PERMITTO Addidon ' AT(LOCATION) 10031DUPONTAVE ZONING DISTRI R•d0 Bldg.Type: Commerdal SUBDIVISION MAP LOT BLOCK 1100.1 1 BUILDING IS TO BE: CONST TYPE 5•B USE GROUP A-3 LOT SIZE construct new restroom addition to Flax Pond Lodge Bldg. REMARKS AREA (SO FT) EST COST ($ $644,875.00 PERMIT FEE ($) 1$0.00 OWNER IFLAX POND RECREATION BUILDING DEPT BY ADDRESS 1114BRoute28 South Yarmouth I MA 02664! RECORD CONTRACTOR LICENSE Burchill. Damon P. O. Box 1539 Harwich MA 02645 5084320530 PHONE 15083982231 FIELD COPY Note Progress - Corrections and Remarks ._ I ME VA, =03=20T."MAMMY WOMEN // . il/ ii. A11 i� " / I fog - y3 49 i`6 01 - - " Official Use Only JJeParGn.nt o/firs services BOARD OF FIRE PREVENTION REGULATIONS [Rev. Occupancy ro ] and Pee Checked �(leave blank 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 (PLEASE PRINTW INK OR TYPE ALL INF0)UI4TI0A9 Cityor Town of: Yarmouth Date: November 1, 2012 To the Inspector of Wires: 0 this application the undersigned gives notice of his or her intention to perform the electrical work described below. LU c 0.1 tioni(Street & Number) 31 Dupont Avenue c`r w o er or Tenant Town of Yarmouth Telephone No. W t z er's iAddress 1146 Route 28 o Of this permit In conjunction with a building permit? Yes Q No ❑ (Check Appropriate Box) uj m rpose fBuilding Recreation Utility Authorization No. fisting ervice Amps / Volts Overhead ❑ Undgrd ❑E No. of Meters ew Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number pf Feeders and Ampacity Location l'and Nature of Proposed Electrical Work: & new chemical storaae feed building at Lodoe e Addition and alterations for completion of the reabOom win Flax I Completion of the follawine table may be waived by the Inspector of Wires. No. of Ricmed Luminaires 22 No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Litminaire Outlets No. of Hot Tubs Generators KVA No of Luminaires Swimming n- Swimming Pool rnd. rnd. o. o mergen cytg mg BatteryUnits 4 No, of Receptacle Outlets 24 No. of Oil Burners FIRE ALARMS No. of Zones 1 No. of Switches 12 No. of Gas Burners o. of Detection andO6 Initiatin Devices No. of Ranges No, of Air Cond. Tons No, of Alerting Devices 09 No. of Waste Disposers eat Pump Totals: um r ohs o. o Self -Contained Detection/AlertinZ Devices _ _ No. of Dishwashers Space/Area Heating KW Local N unicrPa E Other Dialer Connection No. of Dryers Heating Appliances 2 KW 3.5 SecuritySystems:* No. of Devices or Equivalent o. of Water 1 KWo. Heater < o o. o SlLns Ballasts Data Wiring: No of Devices or E uivalent 04 No. Hydromamage Bathtubs No. of Motors 6 Total HP 4 e ommumcatro rung: N Equivalent No. of Devices or OTHER: 120/240, 100 amp sub panel Attach additional detail (jdesire4 or as required by the Inspector of Wires. Estimated Value of Electrical Work: $41,000 (When required by municipal policy.) Work to Start: 11-01-13 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND Q OTHER ❑ (Specify:) I certify, under the pains and penalties ojperjuty, that the information o Is applic on Is true and complete. FIRM NAME: American Electrical Conant tiort, Inc r LIC. No.:20776A Licensee: Robert Sullivan Jr. Signsturrc _ _ — LIC. No.. 40471 E (If applicable, enter "exempt the license number line.) P - Bus. Tel. No: 508-747.5600 Address: 180 Soups Meadow Road, Unit C. PNrnout t. MA 02360 Alt. Tel. No.: 7a1.291.908e *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) 0 owner owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR. RENOVATE. CHANGE THE USE. OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN AONE OR TWO FAMILY DWELLING. Town oFlarmouth Building Deparunrnt 1146 Route `d8 - 1'1rmuti1h. MA U?liti-l- -192 Tel: 508-398-2231 ext. 1261 Fax 508-398-0836 Office Use Only jj Permit ND ,�S�Date>'— Planning Board Information Type Assessors Department Information M% of Permit Fee $ Endorsement Date / m Recording Date New Deposit Rec'd. S Date _ Plan No. 1.4 Property Dimensions: Net Due $ Other Lot Area In) Frontage (it) Lot Coverage This Section for Office Use Only Buildi Permit urn r. Date Issued: Certificate of Occupancy Sig na - Building d a e is is not regjM Section t - Site Information i 1.1 Property Addresas ;;� / Jrlc— 12 Zoning Information: (No Zoning District Proposed Use 1.3 Building setbacks (n) ' Front Yard Side Yards Rear Yard Required I Provided Required I Provided Required I Provided to Water Supply (Y.O.L. a. 40. S S41 Public Privat 1S Rood zone kit ., orc corrunwft I Zone: BFE: Section 2 - Property Ownership/Authorized A ent 2.1 Owner of Records —7,0vt% OF Name (print) Marling Address: Signatt" Telephone Telephone 2.2 Authorized Agent: Name r1nt1 Mailing Address: Signa re Telephone Fax Section 3 - Constriction Services AMP Not Applicable ❑ License Number G5 O /¢g Expirati n Date Ali-z//4 1 of 4 OVER 3.2 Registered company Name 1. Not AMkable p Address Signature Telephone at Registradon Number . Eapirafbn Date I 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 - Professional Design and Construction Services - for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 115 (containing more than 35,000 c.f. of enclosed space) Section 5. Not AppYnble _ - RagisnOw Number Address Explratbn Due Name Name Address Name Address Name 5.2 5.3 for 1, 37I-r'r3�.8 214 Telephone Reapamblay Eapeatbn Not Ap*,able ❑ 2 of Section 6 - Description of Proposed Work (check all applicable) New Construction ❑ (lot multiple family only) No. of Bedrooms (for mui[ipie family only) No. of Bathrooms Existing Bldg. ❑ ReDair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: v /"OI.UG Section 7 - Use Group and Construction Type Building Use Group (Check as appficapable) Contraction Type A ASSEMBLY ❑ A-1 ❑ A-2 A-4 ❑ A-5 ❑ ❑ A-3 ❑ 1A ❑ 1B ❑ B BUSINESS ❑ 2A ❑ 2B ❑ 2C ❑ E EDUCATIONAL ❑ F FACTORY ❑ F-1 ❑ F-2 ❑ H HIGH HAZARD ❑ 3A ❑ 3B ❑ 1 INSTITUTIONAL ❑ 1.1 ❑ 1-2 ❑ 13 ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ 58 ❑ S STORAGE ❑ S-1 ❑ S-2 ❑ U UTILITY ❑ SPECIFY: M MIXED USE ❑ SPECIFY: S SPECIAL USE 1 ❑ SPECIFY: Complete this section If existing building undergoing renovations, additions and/or change In use. Existing Use Group: Existing Hazard Index 780 CM 34 Proposed Use Group: Proposed Hazard Index 780 CMR 34 Section B Bulding Height and Area Building Area _ Existing (if applicable) Proposed Number of floors or stories Floor Area per Floor (s0 Total Area All Floors (sf) Total Height Ill) Section 9 - STRUCTUR, Independent Structural Engine SECTION 10a OWNER OWN I, — 11011 Structural Peer Review Yes_........ No .......... JIV - IU Oc VUMrLCI CU rr rl cl`I APPLIES FOR BUILDING PERMIT / , as Owner of the subject property, hereby authorize ___^� tYi �✓ f �/uG to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 3 of 4 OVER 10b OWNER/ as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Section 11 • ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be completed by permit applicant t. Sul" 2. Eledrkal 3. Plumbing / Gas 4. Mxnankal (WAC) S. FIM Protection Is. Total . (1 . 2 . 3 .4. 5) 7. Total Spuam Ft. larw. oieuw a &"b..1 Check Below ❑ Conservation -Commission Fling (if applicable) ❑ Old Kings Highway 3 Historical Commission approval (if applicable) Date 4 of I\ BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR. RENOVATE. CHANGE THE USE. OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWEWNG. Town oFIlarniouth Building Department 1146 Route 28 - larinotuh. MA 0266 -I t92 Tel: 50&39&2231 ext.1261 Fax 508-398-0836 ice Use Only Planning Baud Information Assessors Department Inlonration: Permit No. '�- Bate .S yx Endorsement Date Map 'I°f % 0/ / Permit Fee $ Recording Date New Deposit Rec'd. S Date _ Platt No. 1A Property Dimensions: Net Due $ other Lot Ana (sf) Frontage (ft) Lot Coverage This Saction for Office Use Only Building Perm! Nu ee I Date Issued: L CertificateOccupancy of Opan Signal toD is Is not req drW Section 1 - Site Information 1.1 property Address: 12 Zoning Inforinadon: Zoning District Proposed Use 11.3 Bunting setbacks (R) ' Front Yard Side Yards Rear Yard 1.4 Mhtar supply (IA.O.t. a 40. s 541 11.5 Flood Zone Inlamatlac Comments Public Private Zone BFE: Section 2 - Property OwnershipdAuthortzed Agent 12.1 Owner of Record: _ Address: Telephone Provided 2.2 Authorized Agent: Name (p tl Mailing Address: QJ,1 �3p! �3�- 8�i� 3� Signature Telephone Fax 3.1 .__l_t2c111.IG Not Applicable C1 License Number 05 of Expiration Date z/13/i t of 4 OVER 3.2 Registered Home Improvement Contractor. Company Name N tAM able ❑ Address Registradon Number - Esplraft Date signature Telephone Section 4 - Workers' Compensation Insurance Affidavit (MAL c. t 52 5 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial f the issuance of the building permit Signed Affidavit Attached Yes .......... No .......... Section 5 -Professional Design and Construction Services - for Buildings and Structures Subject to Constnrction Control Pursuant to 780 CMR 116 (containing more than 35.o0o c.f. of enclosed space) Section 5.1 Registered Architect Name (RKlatnnth Regtstraaon NurtOer Address Erpaatim Data . Name Name Address _. Tnlanlwrw Name Address Name Address 5.3 General �� l fir •-� r� u-�i, C �.fc� company Name Chi or 4A Expiration n Number Dais Not Applicable ❑ 2of 4 Section 6 - Descriptio of Proposed Work (check all applicable) New Construction (for multiple family Dory) No. of Bedro oms (for multiple family only) No. of Bathrooms Existing Bldg. ❑ 1 Repair(s) El I Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify. Brief Description of Pro sed Work: .*4 Section 7 - Use Group and Construction Type Buldng Use Group (Check as appricapable) Construction Type A ASSEMBLY ❑ A-1 ❑ Al ❑ A-2 ❑ A -a ❑ A-3 ❑ to Is ❑ ❑ B BUSINESS ❑ 2A 2B 2C ❑ ❑ ❑ E EDUCATIONAL ❑ F FACTORY ❑ F•t ❑ F.2 ❑ H MGH HAZARD ❑ 9A 3a ❑ ❑ 1 INSTMJWNAL ❑ Fi ❑ 1-2 ❑ IJ ❑ M MERCHANTAE ❑ a ❑ R RESIDENTIAL ❑ _ WI ❑ R-2 ❑ 101-3 ❑ sA 58 ❑ ❑ S STORAGE ❑ S-1 ❑ S-2 ❑ U UTILrrY Cl SPECIFY: SPECIFY: SPECIFY: M MIXED USE ❑ S SPECIAL USE ❑ Complete this section B existing building undergoing renovations; additions and/or change In use. Exisarg Use Group: Existing Hazard Index 7B0 CMR 34 Proposed Use Group: Proposed Hazard Index 7B0 CMR 34 Section 8 BulIdino Helaht and Area Number of floors or aWn Include basamars levels Floor Area per Floor (an Total Area All Floors i Total Heiaht (it) Section 9 - STRUCTURAL PEER REVIEW (780CMR 11011) 1 independent Shucbaat Engineering Sbuctural Peer Review Required Yes....„„.. No ._....- SECTION 10a OWNER AUTHORIZATION - OWNER'S AGENT OR CONTRACTOR APF A as Owner of the subject property, hereby authorize I ':-V4JQVr7 (l"5 R V I to act on my behalf, in all matters relative to work authorized by this building permit application. Date 3 of 4 OVER SECTION 10b OWNER/ AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and acurate, to the best of my knowledge and befief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent I Check Below I ❑ Conservation -Commission Fling (iapplicable) ❑ . Did I(Ings Highway 6 Historical Commission approval rd applicable) Date The Commonwealth ofMassaehusetts Department oflndustrW Accidents Office of Investigations 600 Washington Street Boston, MA 02111 4Qt11DV www.massgov/dia Workers' Compensation Insurance Affidavit: Bul7ders/Contractors/Electricians/Plumbers Aanlicant Information /%,, Please Print Legibly Name pwioess/Organimtiongndividualy � j � 6.�j' f gt! I Lti Are you an employer? Check the tippr 1. ❑ I am a employer with • employees (fall and/or part-time}* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance reqdre&l 3. ❑ I am a homeowner doing all work myself [No work=' comp. insurance required] t 3a. ❑ I am a homeowner acting as a general contractor (referto S4) pJ2DU-1 Phone #: ! Ante box: 4. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employe= and have workers, comp, insurance,t 5. ❑ We am a corporation and its officers have exercised their right of exemption per MGL c. 152. § 1(4), and we have no employees. [No workers' como. insurance reouired.l Y Type pf project (required): 6. (� New construction 7. [3 Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Phmmbing repairs or additions 12.❑ Roof rt pain ME] Other uA—ky hurt #1 must also fill out the socdm below =bowing dickwvtkee C=P=Bdocwcy mfoemsti. .A"51 ho submit this affidavit utdating they ate doing an work and tttm hue ounde taonaeton must submit a new affidavit indtating such. :Cwaaamn that check this boa amched as additional shoot showing the name of the sob�ccmracaa suit state whetba or not those entitin have employees If the sob-wrmarsan have employees, they must provide theu� workicts• comR policy cumber. ! am as employer that li pmIding workas' compe radon [Marance for my employees. Below is the policy and fob site lntormadon. Policy # or Self -ins. Lie. #: Expiration Data Job Site Address 7 ( {/�lfr 714--V City/StateR.ap: PJ23%6 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiation date). Failure to secure coverage as required tinder Section 25A of MGL c.152 can Lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment', as well as civil penalties in the form of a STOP WORK ORDER and a fine Of trp to S250M 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 eer* under the paint 1 r d pe naldies ofpedwy that the Of ftcW we only. Do not write In d ds area, to be completed by city or town oJjklaL City or Town: Permlt/I tense # iy true and coma Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cltyfrown Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone Information and Instructions Maasachmemt Gencral Lawn chapter 152 requires an empkY&s to provide woriom• compemation fa their MVJOe pi =.1 to this statute, an uWUyw is dcfioed as' —evert person in the service of another uuda any coaxd of bite, express or impHed, oral or written." An ayleyw is kLwd as "an h9vidual, partnership. assocsatton, corp=dm cc allots k entity. or aaY two or more of the S. =gaged is & joint cckqKb46 and ic�hadiag the lagal rept.resof a dwased employer, or the rece ran a buster of an iadividaal, PUW =shjp4 assoeiarioa or other legal entity, emplam employees however the awoef of a dwelling hoaae having not man than thrse apertm=bt sad who rcWa -bete'&, at the occupant of tha dwelling boon of amthc who emplaya perwas to do maiau:nzwcS eomuwtiod Or rc* work on such dwelling boast or on the yotmde or building appurtenant tberetn shall not beuvse of snob employment be d==d to be an etpbW MGL chspiw IS2, l2SC(6) dw sWa that "&very s" w kepi lksastag ageaey ska9 wftbbdi the tssaaan sr mnawal da Ifeean or permit to epaafs a bwha or to canswad btsWbW W thin aoaoaw"01 fw 20 appomw wM ban ant peodoesel saepW& nWesea d cemQtEsaa wit! the Imo %M etrrar&p ngwtrw AddWawgy. MGL chapter 132,12XM states "NcMff the tom nmrweshh nor any of in poimol subdEviaiooa shall cats jam way eemtrae-fat the pccf=== ofpublie work until aceept&bla evidence orwmpsance with the; requkc=cc t of thk chapter bars been presented &s the a Y•" Please fill Out the worker&' wapea mdm afIId&Tk complettly. by checttng the bona that apply to yow sibndw and, If &teessay. mPPb tor(s) namds), sddteaa(es) and ph= number(s) aloes with their cmd&ase(s) of ,,,striae= I inited Liability Compama (IJ Q s Limited LLbility PUM=hV (L Lp) with no cm*ym other than the member or, I an not required to Cary wet IM compmation huanaet. if an LLC or UY dons ban eroployam a policy is re -eked Be advised tort thin affidarjt may be sabmimed to the Department Of In 1 Aeaidau fist eoofirmatjaa of jasuraaee eoTcmgs. Ain be state to sip and date the aMavlL The af5d"it should in.. so the city or tow„ the& the KvHadw for the permit cc Hewn is being eegtansed, =I the Depotznt of ln&n uW Ac ddats snimw you have any goestlow rega:dkq the kw or if you an regtt1 0 to obtain a .lame ccc paaad= polky, please can the Department at the ®bin listed below. Sdfiasaed comp®ea ahoafd air their City x Tewa 013da1s Pleas be son that the affidavit is wmpkto and printed k&ly. The Department has provided a span at the bourn or the affidavit for you to Lill out In the event the Offin of Investlgadow ban to contact Yom re ordfag the apPHCXML Please be aura b Hn bt the permiYHiase atmI whirls will ba med a a refeseaa cumber tr addition, ansppHeaut that most submit =Idpk permiV50086 aPPHneiooa in any given Yes, need only submit Clue Affidavit bdkating etazent polky Wz adw (if neeasay) and t=kv -lob sift Ad&ese the applka t should writs "an loeatiow ja _1eatY or tower A wpy of tbo of &vk that bat bee officially stamped of>srked by the city or m" zoey be provided to the applicant ea prod that i rilid affidavit is as fik foe times permim a Uccom A now affidavit mat be fined oat each year. Where a bona owme= at citima to obtaining a Ike= or permit not muted m any btuiom cc wminaciad venture (Le. idol; Hanna or permit to boss term etc) said peaoa is NOT restated to wmpkta this affidavit Thin Office of lavestigWous would Milo to thank you in advmea for your eaopesa600, and should yam have any gontims. pleats do not hesits to girt as a exlL the Depat>ment'a ad&m telephone and fu mtmba : Thin Comm =wealth of Mtsaachusetts Department of Industrial Accidents ova of hwestiptlens 600 Washington Street Boston, MA 021 It Tel. ext 406 or 1-977-MASSAFB Fax 0 617-727-7749 Revised 11-22-06 wwwmws gov/d1S �• oEE R,y TOWN OF YARMOUTH BUILDING DEPARTMENT M PT.FASEPRINK CONSTRUCTION SUPERVISOR•FORM Job Location: '`) l t✓6e?2P Num Owner of Property: 11-1' Construction Supervisor. ( OVA Name Address: M.I 13 Phone No. 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 licenseewho shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 oranyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current ability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No ❑ If you have checked yg5, please innIs the type coverage by checking the appropriate box A flability insurance politq . • 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: of Owner or Owners Owner Q Agent ❑ Signature: Building Official Approval: • 'OF'Y'`tR,� TOWN OF YARMOUTH BUILDING DEPARTMENT o y 1146 Route 28, South Yarmouth, b1A 02664 �.` 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section It 1.5. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at l 0U(60A7t' Work Address Is to be disposed of at the following location: _ ('-('"' 7 �r��./r Lk-, c U--- V$ t2csjVg�? of A<- ctlp� Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. ---j7' , L Signature of App cation Permit No. 6-6 Ildl Date t Massachusetts - Department of Public Safety Board of Building Regulations and Standards Con%truction Supercicnr License: CS-014439 , -23;4 -' THOMAS w IRVWG 275 VALLEY ST S e - Pembroke MA 02359 � it , )11N I'% Expiration Commissioner 03/73/2016 AC7"RDFCERTIFICATE OF LIABILITY INSURANCE 5/6/20114 n THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS -CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORS ED - REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(k:s) must be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s . PRODUCER Hanson Insurance Agency 632 County Road PO Box 668 Hanson NA 02341 CO T Doreen AMachado, CISR ME: PHONE (781)293-6376 '� (711)223-2969 EaAAIL .Doraen@bansonins.com RASU S AFFORDING COVERAGE NAICe INSURERA:Peerless Insurance INSURED Dandel Construction, Inc., DBA: The Landscape 365 Concord Street Rockland MA 02370 iNsuRER9:Safety Indemnity 3618 INSURERc:American Zurich Ins. Co INSURER D:Travelers INSURER E' INSURERF: COVERAGES CERTIFICATE NUMBER:2014 Master/wc pkg be REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSR TYPE OF INSURANCE ADDL sum LILY NUMBER POLICY N ESP LJ11fT3 GENERAL LlABOJTY EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLARAS#IADE FA] OCCUR BR335650942 0/20/2013 0/20/2014 f 300,000 MED EXP " erean S 15,000 PERSONAL 6 ADV INJURY 6 1,000,000 GENERAL AGGREGATE 6 2,000,000 GENT AGGREGATE X POLICYr-1 LIMIT APPLES PER PR0. LOC PRODUCTS -COMPIOP AGO S 2,000,000 S AUTOMOBILE LIABILITY COMEILNEO I SINGLE1 1,000,000 BODILY INJURY O'wPenml S B ANY AUTO �� i X 30ENEDULED NOWOMWED HIRED AUTOS N O 703366 0/9/2013 O/9/2034 BODILY►ARY(Pr aomsq S X PR D S INCL Medipl e S 5 000 UMBRELIALUU3 OCCUR EACH OCCURRENCE S AGGREGATE 6 EXCESS LUUI CLAMS4AADE ED I I RETENnoNs 6 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYIS ANY PROPRIETORTARTNEAE7�lnVE YIN M OFFICEI EMSER EXCLUDED? IDNIA (M- Wy In NH) syy�eAde.obe. w OESCRIPTKRA OF OPERATIONS Deb. _ ZZUB-2E00039-4-16 /27/2014 /27/2013 VAC BTATDRYLIMW OTi4 EL EACH ACCIDENT S 100,000 EL DISEASE• EA EMPLOYEE S 100,000 EL DISEASE• POLICY LIMIT S 500,000 D DESCMPnON OF OPERATIONS I LOCATIONS I VEHICLES "we ACORD lei, ACetlenal RalMda Schedule, ■ mere apace Ia squired) Blanket Additional Insured coverage applies with respect to the General Liability policy only when required by written contract. XCU coverage is not specifically excluded from the general liability Policy. (508)398-0836 Town of Yarmouth Building Dept 1146 Route 28 S Yarmouth, MA ,02664 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOROfD REPRESENTATIVE Machado, CISR/DOREE ACORD 25 0199R-2010 ACORD CORPORATION_ All rights reserved INS025 pmaowi The ACORD name and logo ari registered marks of ACORD ,+ ► TOWN OF YARMOUTH d Building Department a Town Hall Yarmouth, MA 02664 (508) 398.2231 exL1281 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-14-600 Applicant Name: Thomas Irving Applicant Phone: 3399338919 Building Location: 0031 DUPONT AVE Owner's Name: TOWN OF YARMOUTH /FLAX POND Owner's Addres 1146 Route 28 South Yarmouth MA 02664 Owner's Telephone: (508) 398-2231 (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 5/12/2014 Issue Date: 5/12/2014 Expiration Date 11/1212014 Comments: Map/Lot: 100.1 construct a shade structure as per plans dated 05/12/14. REVIEWED BY: 1. WATER DEPARTMENT: DATE: WA: 2. ENGINEERING DEPARTMENT: DATE: WA: 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: DATE: WA 5. BUILDING DEPARTMENT: DATE: WA: 6. FIRE DEPARTMENT: DATE: WA: PLEASE NOTE COMMENTS: RECEIPT OF COPY. SIGNATURE OF APPLICANT: DATE: Date Printed: W13/2014 BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR, RENOVATE. CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. Tossil of Yarmouth Building Departtnrrit 1146 Route 28 - Ytnnouth. MA 02664-1-192 To": 50&39&2231 ext. 1261 Fax 50&39&0836 ice Use Only Permit No. '/I/- ate Permit Fee $ Planning Board Information 4type Endorsement Data Assessors Department Infomution: Map�� Recording Cate New Deposit Rec'd. $ Date _ Marl No. 1.4 Property Dimensions: Net Due $ Other Lot Area (sf) Frontage (ft) Lot coverage This Section for Office Use Only Building Permit Nu e I I Date Issued: Signs W L Datal I 11 Certificate of Occupancy . is Is not mgAred Section 1 - Site Information 1.1 Property Addressi 1.2 Zoning Infor)t+efffor : Cu1�aa-rLc y Zoning District Proposed Use 1.3 9ulldlnp Setbacks (n) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1A Wistar Supply (M.2L- r—40.! 341 1.5 Flood Zone Informsfi= cornrr wft Public Private Zone BFE. Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record- W ,ram Nam pri) —/ Mailing Address: a& Soo -VL,OIJ7_ -2?7AI sCT /G,?'-A Telephone ba>J�c. Camel �u Name (p tl Signature Telephone Section 3 - Construction Services 3.1 Ucansed Construction Supervisor. TIj ter— r,U . I(2c) j)IG Telephone Mailing Address: -v-� Not Applicable ❑ License Number old. Expiration Date 3113/16 1 of 4 OVER 3.2 Registered Home Improvement Contractor. Company Nona Not Appeoable ❑ Address Pegisbadon Nwnber Eapitaaon Date Signature Telephone Section 4 - Workers'Compensadon 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 f the issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... Section 5 -Professional Design and Construction Services - for BuBdings and Structures Subject to Contructitxt CorttroI Pursuant to 780 CMR 116 (containing more than 35.000 c.f. of enclosed space) Section 5.1 Registered Architect Not AppYOble ❑ Name (Regiatrant)i Reost awn Nwrbw Address Expintbn Dale C � Not Appriicabla ❑ 2 of Section 6 - Descriptio of Proposed Work (check an applicable) New ConstrucnGn (for multiple family only) No. of Bedrooms (for multiple family any) No. of Bathrooms Existing Bldg. ❑ I Repalr(s) ❑ 1 AHerations ❑ I Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Pro sed Work: Section 7 - Use Group and Construction Type Bunting Use Group (Chedc as applicapable) Construction Type A ASSEMBLY ❑ M1 ❑ A-2 ❑ AJ ❑ A-5 ❑ A-3 ❑ to ❑ 18 ❑ 8 BUSINESS ❑ 2A ❑ . 29 ❑ 2C ❑ E EDUCATIONAL ❑ F FACTORY ❑ F-1 ❑ F-2 ❑ H HGH HAZARD ❑ 3A ❑ 39 ❑ . 1 INSTmJTIONAL ❑ 1-1 ❑ 1-2 ❑ 1.3 ❑ M MERCHANTRE ❑ 4 ❑ R RESIDDI IAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ 5e ❑ 5 STORAGE ❑ S-1 ❑ 5-2 ❑ U UTILITY ❑ SPECIFY SPECIFY. SPECIFY: M MIXED USE ❑ S SPECIALUSE ❑ Complete this section If existing building undergoing renovations; additions and/or than In use. Exlsnrg Use Group: Existing Hazard Index 780 CMR 34 Oroposed Use Group: ' Proposed Hazard Index 78G CMR 34 Section 8 Buildingeight and Area Bufk irg Area Bdstirg (f applicable) Proposed Number d noon or storks InNude basement 4"Is Floor Area per Floor (sq Total Area Al Floors (sf) Total Height (ft) Section 9 - STRUCTURAL PEER REVIEW (780CMR 110117) Independent Structural bxal Engineering structural Peer Review Required Yes SECTION 1 Oa OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. ., as Owner of the subject property, hereby authorize %'H Cyr[ h--5 -1 rL V l b r6 to act on my behalf, In all matters relative to work authorized by this building permit application. Si a of Ovme Date 3 of 4 OVER 10b I, " -T , as Owner/Authorized Agent hereby declare that the statements and Information on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of 0wrwr/Agxrt Daze I Check Below , I ❑ Conservation -Commission Fling (if applicable) ❑ Old Iangs Highway 3 Historical Commission approval (if applicable) 4 of The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 01111 `$�' www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElecMcians/Plumbers Applicant Information Please Print Legibly Name I LA Are you an employer? Check the Mppr 1. ❑ I am a employer with . ' employees (fall and/or part-time' 2. ❑ I am a sole proprietor or partner- ship and have no employees working for mein any capacity. (No workers' comp. insurance rcqdre&1 3. ❑ I am a homeowner doing all work myself [No workers' comp. t 3a. ❑ Iam a bomner acting as a general contractor (refer to #4) pJst" Phone # 'S date box: 4. ❑ I am it general contractor and I have hired the sob-couCacto s listed on the atmehed sheet. These s have employees and have worker' Comp. inamanrGt 5. ❑ We are a corporation and its officers have exercised dick right of exemption per MGL c. 15Z § 1(4). and we have no employees. [No workers' comp. insurance remared l -a-53 -Gq Type gtproject (required): 6. New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Bln7dmg addition 10.0Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roofrepain 13.❑ Other •Amy applirao drat checb box #1 mast dw fill oat the section below Thawing du irworkers' eompen"dodwxy tafocmtim t Homeowoaa who submit this d5davit indenting they m doing all wort zed dux him outside eoonacots most submit a new affidavit indeating such, rCwnaetam that el—kc duo box rust attached an adddom! sheet showing the name of the sobtoonaGan sod rum whedw,cone those entitles have employees If the alb-emtractas have empbyeea, they mast provide their wodas' eoogr, policy number . Ian as employer that u prodding workers' congmmadon btssoancefor my employee. Below it the poAey and job site Information. irr-rrfl Gs - Policy # or Self -ins. Lie. #. Expiration Date: Job Site Address 7 ( 'h()'jt r !w City(StatrMp: trJ 231,4�; Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can Lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $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 cerdf jh umder the pairls �vd penaIda of perjary that the beformadom prodded yboye Is true and correct OAMal use only. Do not write In this area, to be completed by city or town ofikial City or Town: PermitAUcense # 14V Issuing Authority (circle one): L Board of Health 2. Building Department 3. Cityfrowu Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: Information and Instructions Musaohnwm General Laws chapter 152 requires all employers to provide wmima' =Wm>tica fa their cmpkycm p=uaat to this rtatutr. an arpfget is de8aed u .—every pawn in tbs service of amd= ruder nay I'm fsac'Of hits. . cq=ss a implied, oral or written." .' An sarrlayw is defined as "era individual, patnersh* associetioa, corporation a other legal eaft or asp two a mote of the foregoing agaged. is a joint; eaterytiM and iochrdmf the legal L.W.CIMCUdy of a decried empbm or the receiver, CC' " - P of n iadhidaaL partnership, associatim a other legal eadty. empbyioli employees Hamm the owner of a dwelling honer having not man than three >patraenb and who resides tberchk cc the ... I of of the dwelling house of amehw who employe pcmm to do mrictesanc% cuneernctim ac repair wort on such dwelling house or on the pomade cc bmiding gVmt=ms thereto shell net beeaaes ofsoch employment be deemed to be sn empbW MGL chspeer 152. f 1SG0 dw sierra that "every stab w bwW lknzf agesey spry wld th@W the lssaaacs er renewal at a Kenn w permit to operab ■ bedw or is eeasbuct beddlap V the emu=dm d* fir asp sppsc2m wM boa tart prodded acceptable aldesee at eemplEsan wi* the imerum cIvmW rsgdrW AdditlaoeCf. M(3L cl apeer 1A 12XM seats "Neither the com®aweahh nor any, of its political subdivision shad eater loco any cosset for the paeformeoce ofpabdit a wait until acceptable evideaca of oompBanca with the inatsaee regnirements of this cbspeer bare been presented eo the emhsetiag enshoriey." Applies" . Pleasa is oat the wortes , eon aatioa affidavit eomplebly, by checking the homes that apply to your simatim EA if necasssey, soppy sab4couaeta(s) names). oddness(es) and phooe au®ber(s) along with their caadeaee(s) of ianasaes I inured Liability Caepanin (LLQ or Limimd Liability Pasmashipa aM wide on employees otter titan the memI ers err psrtam. an not required is carry wockm' com>pensatiom bIf an LLC err LLP don have enVbycM a policy b required. Be advised tut this aftWavit may be submitted to the Department of lodutrial Accidents hr eom8zumdm of maoraoee coveragm Abe be sure to alp and date the atddsvit. Thor affida it should bar, I is the city or town that the application Por the pa:mt or tieenas In being ee , ' L art the Department of Idustrisl Aeeidenb. Should ym hart any gores -I rep ding tba law er if you ate mgmred err obtain a workaa• compeasstion policy, plew cad tr Department at the ®ben listed below. Sill-inaasd coa>pmia should ata their self-tn>naaee lieenas auombar an the epgop tier~ hoe city or Tetras Ofditiais Plain be son that the affidavit is eomglas and printed legibly. Ths Depanatmt has provided a spsca at the honor of the affidrvit for you to ®1 oat in the eureat the Office of lave tigsdons has to coated yam a IF the applicant, Pleas be sire to Hd in the padNkeam atmI which wn71 be used an a reference nambac In addition. an Rr 11 1 that mist submit multiple pernmt/Bcmas applicatim is say gives, yew. need only submit our affidsvit iodinating concur polity blis mdm (if neceuray) and under "Job Site Add ue the amlics should write %U loodom ta----(city or town)6" A copy of the affidnk that has boa officially stamped or marked by the city or taws my be provided to the applicant as proof that i valid affidavit has Me lor tidun permits or lieenees A new affidavit must be Mod out eseh year what a hmma owner or citfsss is obtaining a license at permit not related to, any business at cmnm=W venare (Le. r dog Beale at perrmt to bum leaves ter.) said pesos is NOT requdr 1 to cmvkm this sffidn& The Offica of haratgatba would IU to thank you is adnaca for your cooperation ad should you have any gmsdom please do not hesitate to give as a cad. rba Departrraat's addmatelephone and far mmtI The Comm awealth of Nimwh Butts Depattmmt of Industrial Atxitients Ofl;es of kyeoptleas 600 Washington 3tt d Boston. MA 02111 Tel. li 617-727.4900 ext 406 or I-i177-MASSAFE Fax / 617-727-7749 Revised 11-22-06 wwwm=pv/din TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: job Location:_ Owner of Property: Construction Supervisor. Address: Licensed Designee: (If other than Supervisor) IJvrrv1JrP f,e Street Name License No. Name 2.15 Responsibility of each license holder. License No. ,-�Q6Phone 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, 6not 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 oranyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current ability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No ❑ If you have checked = please Inds to the type coverage by checking the appropriate box A liability Insurance policy . Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 152 of the Mass. General laws, and that my signature on this permit application waives this requirement Check one: of Owner or owners Owner ❑ Agent ❑ Signature: Building Official Approval: TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext.1261 Fax 508-398-0836 1 1 1 1 ' o; l ►YI DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1115, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at'?;) t (DU((')vA'7t' Work Address Is to be disposed of at the following location: ( L��`"7 �GT�iR/�� ct,ccc� c t�tt;`nt of ,d-1-t�/,¢� tAkv Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. -'--�JUAC Signature of App cation Permit No. 6-6 //p Date Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Super%hor License: CS-014439 ,R b iHOJ1AS W IRVIfTG '. /.0 275 VALLEY ST Pembroke I 0 fl59 Expiration 03l13l2016 Commissioner �1. "� CERTIFICATE OF LIABILITY INSURANCE °4 5/6/2014 /6/20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIMD REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: H the Dertificats holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to -the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in Neu of such endorsemen s . PRODUCER Hanson Insurance Agency 632 County Road E: Doreen Machado, CISR FRONE (781)293-6376 (lfl)291-29f9 eALltG.DoresnBhansonina.cm PO Box 668 Hanson HA 02341 AFFORDING COVERAGE NAc6 WSURERA:Pearless Insurance INSURED muRERs:Safety Indemnity 3618 Dandel Construction, Inc., DBA: The Landscape INSUREReAmerican Zurich Ins. Cc 365 Concord Street enuRERD:Travelers INSURER[: Rockland HA 02370 INSURER F• COVERAGES CERTIFICATE NLIMRFR-2014 Master/wa nko )x r:cwrsrnu unuaco- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. N R TYPE OF INSURANCE ►OLICr M1MBER POLICY EFF POLICY ■ QP Lam GENERAL LIABILITY EACH OCCURRENCE f 1,000,000 A X COMMERCIAL GENERAL LNBIITY CLAIMS -MADE a]OCCUR BUSS650842 0/20/2013 O/20/2014 DAMAGE TO ROM PREMISES 8�1f LIED EXP a 300,000 6 15,000 PERSONAL S ACV NARY $ 1,000,000 ' GENERAL AGGREGATE 9 2,000 000 GENL AGGREGATE X POLICY LIMIT APPLES PER reWCTD' LOC PRODUCTS -COMP)OP AGG f 2,000,000 s AUTOMOBILE LIABILITY COMBINEDlockwIl 2 1,000,000 BODLRrrm YNAY(Pap) S B ANY AUTO �OWNED r:M X AUTOS 703366 0/9/2013 O/9/2014 BODILY HARY(PW eoddwO 6 X MOCILWOf INM NRED AUTOS X ANON-O UTOS Meftd S 5.00 UMSREUALIAB OCCUR EACH OCCURRENCE IIIEXCESS AGGREGATE f LuxCLAIMS-KIDE OED I I RETENTION B C WORKERS COMPENSATION AND EMPLOYERS LIABILITYFR ANY PROPRIEIOANAAINERIFJfIVE YIN ANY P OFFICE"El fOfCLIIDEOT (M..won In NN) I ftscrbew DESCRIPTION OF OPERATIONS below NIA ZZUB-2r00038-4-14 /27/2014 /27/2013 I WCSTATLL I JOTI+ EL EACH ACCIDENT 5 100,000 EL DISEASE - EA EMPLOYEE S 100,000 EL DISEASE -POLICY LIMIT S 500.00 D DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAsrA ACORD 10t, AdMiaW Rants Sd"ft■ eon pA Ym**e ) Blanket Additional Insured coverage applies with respect to the General Liability policy only elan required by written contract. ECU coverage is not specifically excluded from the general liability policy. (508)398-0836 Town of Yarmouth Building Dept 1146 Route 28 S Yarmouth, HA 02664 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W ACCORDANCE WITH THE POLICY PROVISION& Machado, CISR/DORLE �� 25(2010T05) INS=Tmlam) t The ACORD name and logo are registered marks of ACORD reserved. Temp Permit No.: Applicant Name: Applicant Phone: Building Location: TOWN OF YARMOUTH Building Department Town Hatt Yarmouth, MA 02884 (508) 398.2231 941281 BUILDING PERMIT TRANSMITTAL T-14-380 Thomas Irving 3399338919 0031 DUPONTAVE (OFFICE USE ONLY Recorded By,. IC Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 5/6/2014 Issue Date: Expiration Date Comments: Map/Lot: 100.1 construct gazebotokeiow—M.at Flax Pond Owner's Name: TOWN OF YARMOUTH/FLAX OPND Owner's Addres 1146 Route 28 South Yarmouth MA 02664 Owner's Telephone: (508) 398-2231 ' REVIEWED BY: 1. WATER DEPARTMENT: DATE: WA: 2. ENGINEERING DEPARTMENT: DATE: WA: 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: DATE: WA: 5. BUILDING DEPARTMENT: DATE: WA: 6. FIRE DEPARTMENT: DATE: WA: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 5/6r2014 A✓ �e CERTIFICATE OF LIABILITY -INSURANCE 5/6/201od » THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTTME A CONTRACT BETWEEN THE ISSUING INSURER(Sh AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFlCATE HOLDER IMPORTANT: H the certificate holder b an ADDITIONAL INSURED, the pOOcy(Ies) must be endorsed. H SUBROGATION IS WANED, subject to ds terms and conditions of the policy, certain policies may require an endorsement. A statement on this Certificate does not confer rights to the certlRcate holder In Neu of such endorsemen s ►IuODUL1:Rt Hanson Insurance Agency 632 County Road 20 Box 668 Hanson NA 02341 2NN7Ur;Doreen Hachedo, CISR ►HONE (781)293-6376 PAX R,rrlau-alit •� ,DoreenO hansonias. com rr"En APFORDMCOVERACE NAIC9 INSUREBA:peerless Insurance MURED Dandel Construction, Inc., MBA: The Landscape 365 Concord Street Rockland HA 02370 lH9vRzRv;Safetv Indemnity 33616 wsuRERcAmerican Enrich Ins. Cc INfumb:Travelers INSURER 1 INSURERP COVERAGES CERTIFICATE NUMBER:2014 Master/wc 1pkg ba REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRIYPi or 1IrgIRANca yANNA; Lean A GENERAL UASLRY X COUMERQALGENEIMLVALRY CLAMS -MADE ® OCCUR BKS33950942 0/29/2013 0/20/2014 EACH OCCURRENCE a 1, 00,000 N zSLMI S tft S 300,000 MED EV ew vten a 13,000 PERSONAL a ADV ►JURY S 1,000,000 CENERAL A00REGATE f 2,000,000 GEN% AGGREGATE UNrr APPLIES PER X valor PRO' oc PRODUCTS-COUPAP AGO t 2,000,00 a H AYTOYoa1.e uA ANY AUTO ALL OVM0 %( AUCTODSIAW NOPLO HIRED AUTOS X AUT03RHED 703369 D/r/2D17 0/9/2014AUTOS CETL8IIIE 0 114SLP JMT 1 000 000 aODILYSQURYF-Pew) t BOOL7 N.ElRY �r taideSl t X Pav PERRTY AM E t I10CL Medal f 5.000 UYBREJ.A LMa E XESS We OCCU1 CLAFAS44AM SACH OCCURRENCE t AGGRCGATE f f C WARNERS COM►EN9ATION ANDEMPuarria'umnuTY YIN ANY PRORMITOMPARTNERIE CUTNE ❑ OFFI(""InMEM3ER ECCWDED7 Me,bwryMNH) If yn, barb, w om DESCRIPTION F e 'n S t NIA s2tJ8-2r00039-4-SA /2T/2oU /27/2013 I wCETATu IOTw tUu EL EACH ACCIDENT t OO 000 E,LDREASE EAEMPL a 3o0 0o0 E.L CI6EMP000YUMT a 00 000 D DESCRV7M OF OrmAnow ILOCATGraIVWCLESIARea ACOIO),OT. AeMiad Rend. adedb, E sort,tea Is rMwom Blanket Additional xneurad coverage applies with respect to the General Liability policy only when required by written contract. XCO coverage is net specifically excluded from the general liability policy. (SOB)398-0836 Town of Yarmouth Building Dept 1146 Route 28 S Yarmouth, M 02664 aHOULD ANY OF THE ABOVE DESCRIBED POLICIES 66 CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE MILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISION& AUTHORIZED RPPRUWTATM Machado, CSSR/DoRLL ACORD 25 (2010/0S) INS025pmoaalor XD 1998-2010 ACORD The ACORD name and logo am registered marks of ACORD reserved. @-Uo@ 0' 9 A Dlmlon of PORTERCORP 4240 M 136n AVE KXIAND, MI 49424 (616)39L1963 Dnlpna and caWa "of Pdigon EuYdkvs ara protadad urldR copyngM laws and pabnb aed may not W and In Mr mnsWodan w design d a Wd&N dW Is not applied by PON= Cuppo laws "ad PM "and visual appearam* d"aaudua Wao Pa may "r o p" et Sn design, PATENTED ANDOR PATENTS PERDWO COPYRIGHT 2014 PORTERODRP HOIIMD, 4149424 PROJECT NAME: FLAX POND PROJECT LOCATION: YARMOUTH, MA BUILDING TYPE: RAM 16X24 ROOF TYPE: MULTI -RIB JOB NUMBER: 51753 DRAWING LIST: SHEET NUMBER DRAWING DESCRIPTION CS COVER SHEET 1 ARCHITECTURAL ELEVATIONS 2-2.1 ANCHOR AND FOOTING LAYOUT / DETAILS 3 STRUCTURAL FRAMING PLAN 4-4.1 IFRAME CONNECTION DETAILS 5-5.1 IROOF LAYOUT 6-6.2 IROOF CONNECTION DETAILS MANUFACTURER NOTES: 4 MATERIALS: DESCION TUg RIPTEL SCHEDULE PIPE RMT PIPE LIGHT GAGE COLD FORMED STRUCTURAL STEEL PLATE ROOF PANELS (STEEL) ANCHOR BOLTS BE STOM DE, IGS N AA530(G(GRRADA E B) AID03 (GRADE 50) A36 A653 SEE SHEET 2.1 STRUCTURE WAS DESIGN OF THIS STRUCTURE CAN BE REVIEWED AND POSSIBLY REVISED ETC.) SO THE \T TO UNLESS NOTED OTHERWISE, THIS STRUCTURE WAS DESIGNED ASSUMING A 27 SEPARATION BETWEEN ANY ADJACENT STRUCTURE WITH AN EAVE HEIGHT EQUAL TO OR GREATER THAN THE EAVE HEIGHT OF THIS STRUCTURE. IF THAT SEPARATION DOES NOT, EXIST, POLIGON MUST BE CONTACTED SO THE DESIGN OF THIS STRUCTURE CAN BE REVIEWED AND POSSIBLY REVISED. STRUCTURAL STEEL SHALL BE DETAILED, FABRICATED, AND ERECTED IN ACCORDANCE WITH THE LATEST EDITION OF THE AMERICAN INSTITUTE OF STEEL CONSTRUCTION (AJSC) SPECIFICATION MANUAL ALL WELDING IS PERFORMED BY AMERICAN WELDING SOCIETY CERTIFIED WELDERS AND CONFORMS TO THE LATEST EDITION OF AWS D1.1 OR D1.3 AS REQUIRED. PARTS SHOWN MAY BE UPGRADED DUE TO STANDARDIZED FABRICATION. REFER TO THE SHIPPING BILL OF MATERIALS AND FINAL INSTALLATION INSTRUCTIONS INCLUDED WITH THE STRUCTURE FOR POSSIBLE SUBSTITUTIONS AND IMPROVEMENTS. OF THE BUILDING IT DOCUMENTED EXPERIENCE fOR PROPER FIELD INSTALLATION OF THE BUILDING IT IS RECOMMENDED THAT ELECTRIC WIRING, IF REQUIRED, BE RUN THROUGH THE STRUCTURAL MEMBERS BEFORE THE BUILDING IS ERECTED. FABRICATOR APPROVALS: CITY OF PHOENIX, AZ APPROVED FABRICATOR #CO8-2010 CITY OF LOS ANGELES, CA APPROVED FABRICATOR #1596 CITY OF RIVERSIDE, CA APPROVED FABRICATOR #SPD6.0033 CITY OF HOUSTON, TX APPROVED FABRICATOR #470 CLARK COUNTY, NV APPROVED FABRICATOR #264 STATE OF UTAH APPROVED FABRICATOR 02008-14 CERTIFICATES: MIAMI-DADE COUNTY CERTIFICATE OF COMPETENCY NO. 13-0813.16 PCI (POWDER COATING INSTITUTE) 4000 CERTIFIED DESIGN CRITERIA: GENERAL: 2009INTERNATIONAL BUILDING CODE OCCUPANCY CATEGORY: II DEAD LOAD: ROOF DEAD LOAD: 2 PSF FRAME DEAD LOAD: SELF WEIGHT LIVE LOAD: ROOF LIVE LOAD: 20 PSF SNOW DESIGN DATA: GROUND SNOW LOAD (Pg): 30 PSF FLAT ROOF SNOW LOAD (PO: 25 PSF SNOW EXPOSURE FACTOR (Ce): 1.0 SNOW LOAD IMPORTANCE FACTOR (Is): 1.0 THERMAL FACTOR (CQ: 1.2 WIND DESIGN DATA: BASIC WIND SPEED M:120 MPH GUST EFFECT FACTOR (G): 0.85 WIND IMPORTANCE FACTOR Iw): 1.0 INTERNAL PRESSURE COEFF C.IENT (GCpi): 0 WIND EXPOSURE: C SEISMIC DESIGN DATA: STEEL SYSTEMS NOT SPECIFICALLY DETAILED FOR SEISMIC RESISTANCE SEISMIC IMPORTANCE FACTOR (le): 1.0 SEISMIC DESIGN CATEGORY: C SEISMIC SITE CLASS: D SEE CALCULATIONS FOR ADDITIONAL DATA ADDITIONAL CRITERIA: NONE TOWN OF YARMOUTH REVIEWED FOR BUILDING AND ZONING CODE COMPU- ANCE ERRORS OR OMMISSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPO IUTY OF' ILT' COMPLIANC NOTICE An as built plan must be submitted to this department prior to foundation inspection or any furthor construction. Fi ,o a� �S v2 Q 2 r O ru w Z v=i2 O0 .ce > w x > U nU 33 &iEET (/ o VV E a u O a 0 U P! CL a a a= � 5 ' o i is a. �z Ll 1iy r� 16'-0' REF. ~ R C O a N m z > Q� a_ rr 24'-0" REF. X C.) Q � o i Q S N Z O 19-8 7/8" < H >>a REF. W 7-11 3/8" - = J w UNDEREAVE � Q O O tH OF Afq, 9 Z O < > U� os r G cH'SISTO?HE1i r.1 in U _ EVVI _ 3 sy 1 FINISH GRADE FINISH GRADE 1: ca f\ SHEET 2.1 (ASSUMED AT CONSTANT ELEVATION (ASSUMED AT CONSTANT ELEVATION q T e ` T�Ff 3 UNLESS OTHERWISE NOTED) UNLESS OTHERWISE NOTED) iS S, Of s1�Er sT1E6E DN/�N1Npl hRE 6EM£p, THE 6FAL MPIIEI ONLY TO �ULplq LOMPpNE1rt! NNp EgINp�TON pEB1pN / /JPIIGBLE) pETIJIEp MATMN TNE6E DMMANOB. ANCHOR AND FOOTING LAYOUT NOTES: 1. ANCHORS MUST BE CENTERED IN FOOTINGS 2. FOOTINGS MUST BE TURNED TO ALIGN WITH COLUMN AND TRUSS CENTERLINE. m O Y J L7 Q z O x O LL cO < Q Z Q � O O 1>- x O Z J Q an I FOUNDATION NOTES: 1. ALL MATERL4LS AND WORKMANSHIP SHALL CONFORM TO THE REQUIREMENTS OF THE BUILDING CODE, AMERICAN CONCRETE INSTITUTE, AND ALL APPLICABLE STATE AND LOCAL ORDINANCES AND REQUIREMENTS. 2. THE CONCRETE DESIGN IS BASED ON THE FOLLOWING PROPERTIES: • 28 DAY STRENGTH OF 3000 PSI. SLUMP OF 4" (+Al"). 3. THE FOOTING SHALL BEAR ON COMPETENT UNDISTURBED SOIL OR 95% COMPACTED FILL IF SIGNS OF ORGANIC MATERIAL, UNCONTROLLED FILL, CLAY OR SILT, HIGH WATER TABLE OR OTHER POSSIBLE DETRIMENTAL CONDITIONS ARE FOUND, INSTALLATION OF THE FOUNDATION MUST BE DISCONTINUED AND A SOILS ENGINEER CONTACTED. 4. THE REINFORCING STEEL SHALL CONFORM TO THE REQUIREMENTS OF ASTM A615, GRADE 60. 5. IF FOOTING DEPTHS SHOWN DO NOT MEET LOCAL FROST REQUIREMENTS, USE THE DRILLED PIER FOOTING OPTION AND EXTEND AS REQUIRED. EXTEND VERTICAL BARS AS REQUIRED AND PROVIDE ADDITIONAL TIES TO MEET SPACING REQUIREMENTS AS SHOWN. IF LOCAL FROST DEPTH REQUIREMENTS ARE NOT MET AND NO DRILLED PIER FOOTING OPTION IS GIVEN, CONTACT POLIGON ENGINEERING. IT IS THE CONTRACTOR'S RESPONSIBILITY TO VERIFY THE LOCAL FROST LINE DEPTH BELOW GRADE PRIOR TO 5' 3" CLR 3" CLR 3 OF THE BUILDING CODE (CLASS 5 SOIL). THE JURISDICTION IN WHICH THIS STRUCTURE IS ;ITE SPECIFIC GEOTECHNICAL REPORT OR LOCAL PROFESSIONAL ENGINEER ATTESTING SITE CONDITIONS MEET THE ASSUMPTIONS DRILLED PIER FOOTING OPTION DESIGN BY POLIGON MATERIALS BY OTHERS. b 646 VERTICAL BARS (EQUALLY SPACED( #4 TIES HORIZONTAL ® 12" O.C. w/2 TIES IN THE TOP 5" (QUANTITY OF REINFORCING •--�i 3" CLR SHOECT REQUWINGSIREMENTS) MAY NOT —�1II REFLECT REQUIREMENTS) Z-4r DIA. MIN. SQUARE FOOTING OPTION FOOTING DESIGN BY POLIGON FOOTING MATERIALS BY OTHERS. 3" CLR I'-6" MIN. I 3"C 3" CLR 3'-6" MIN. COLUMN LOCATED AT CENTER OF FOUNDATION LR� (QUANTITY OF REINFORCING SHOWN IN DRAWINGS MAY NOT REFLECT REQUIREMENTS) THE AMERICAN INSTITUTE OF STEEL CONSTRUCTION MANUAL (PART 14), 13th EDITION. 3. HOOKED ANCHOR BOLTS ARE NOT ACCEPTABLE. 4. ACCURATE ANCHOR BOLT PLACEMENT IS CRITICAL. TO ENSURE THE ANCHOR BOLT LAYOUT MEETS THE DIMENSIONS REQUIRED ON THE DRAWINGS, SURVEY (OR MEASURE) THE LOCATION OF ALL ANCHOR BOLTS PRIOR TO POURING THE FOOTINGS. AN ADDITIONAL SURVEY (OR MEASUREMENT) SHOULD BE MADE AFTER THE FOOTINGS ARE POURED TO CONFIRM THE ANCHOR BOLTS DID NOT SHIFT DURING THE CONCRETE POUR. 5. POLIGON STRONGLY RECOMMENDS USING ANCHOR BOLT TEMPLATES BECAUSE THEY SIGNIFICANTLY IMPROVE THE ACCURACY OF ANCHOR BOLT PLACEMENT. AN ANCHOR BOLT TEMPLATE IS PROVIDED WITH ANY PINNED BASE ANCHOR BOLT KIT PURCHASED FROM POLIGON. 6. IF OUTSIDE CONSULTING ENGINEERS ARE DESIGNING THE FOUNDATIONS FOR THIS STRUCTURE; THEY MUST REFER TO POLIGON CALCULATIONS FOR MINIMUM CONCRETE PROPERTIES (COMPRESSIVE STRENGTH, EDGE DISTANCE, ETC.) REQUIRED FOR THE ANCHOR BOLT DESIGN. 7. ELECTRICAL ACCESS HOLE IS ALWAYS LOCATED IN THE COLUMN BASE PLATE AS SHOWN. RF SURE TO KEEP THE ANCHOR BOLT TEMPLATE PROPERLY ORIENTED WHEN ELECTRICA r" \ 011/8"THRU Q• 3• ELECTRICAL ACCESS HOLE TYP. 1 1/ P. ARROW TIP ON TEMPLATE POINTS TO TRUSS SIDE OF COLUMN. 4X O3/4" THRU ANCHOR BOLT HOLES N 2 ANCHOR BOLT PATTERN 2 BASE PLATE THICKNESS: 1/2" ANCHOR BOLT SUBSTITUTION THE FOLLOWING EPDXY ANCHORS MAY BE SUBSTITUTED FOR THE CAST IN PLACE ANCHOR BOLTS ABOVE: -HILTI HIT-HY 200 ADHESIVE w/ 01 /T HAS ROD WITH A MINIMUM 6" EMBEDMENT. -SIMPSON EPDXY -TIE (SET) ADHESIVE w/ 01/2"ALL. THREAD RODS (ASTM A307) WITH MINIMUM 6" EMBEDMENT. 0117'X10"LONG • ANCHOR BOLT " (4) PLACES ..• .. _• 1 ANCHOR BOLT DETAIL OF FOOTING FINISH GRADE (ASSUMED AT CONSTANT ELEVATION UNLESS OTHERWISE NOTED) B" MIN. EMBEDMENT O CONCRETE FOOTING FOOTING MIMSTOPIlE6 \�N fi 0 2.1 O e o G o c U ^ O 6 0 WW F 4 5 C 3 7 p' T-100 O SHEET 4 2 s P-100� g SHEET 4.1 8f R� K-100 . R �O SHEET 4 A-100 01' SHEET 4.1 c m M 'n � a < h N z~ > K w R < cn QLo o L gK O z I 10'-7 1116" REF. UTM z Q .J a FINISH GRADE FINISH GRADE (ASSUMED AT CONSTANT ELEVATION (ASSUMED AT CONSTANT ELEVATION � Z UNLESS OTHERWISE NOTED) UNLESS OTHERWISE NOTED) m yjHOFMAsr'c Z O Ix Cie 8 4 - T-TAIL ASM HSS4"X4"Xl/8" Q 7 2 - PURLIN SIDE ASM HSS4"X4"X1 /8" 2 CHRISTO?HER Ill CL } u 6 2 - PURLIN END ASM HSS4"X4"X1 /8" Ec`. I' 5 1 - RIDGE BEAM ASM HSS5"X3"X1 /8" 4 2 - T-MEM SIDE ASM HSS6"X4"Xl/8" 3 2 - T- MEM END ASM HSS6"X4"X 1 /8" 2 4 - TRUSS ASM HSS6"X4"Xl /8" 1 4 - COLUMN ASM HSS6"X6"X3/16" 3 ITEM QTY. PART NO. DESCRIPTION MATERIAL V THESE DMKIMGS IJtE EEAIFD. THE 6EM1L MPllE3 dlT TO DETMED NITMN THESE p11111HDf. ""`°'"°`°"°°"E""""°E°"'��°°"°�"D"`"°"U" NOTE: SEE UC-100 FOR U-CLIP INSTALLATION NUT, HEX, 314-10 (2) PLCS EACH CONNECTION 3/8"PLATE w/ 1 /4" FLG. PLT. TENSION 1 /2" PLATE w/ 3/8" FLG. PLT. NUT, HEX, 5/8.1 (2) PLCS EACH COLUMN CONNECTIONS NOTE' TURN -OF -NUT PRETENSIONING METHOD: COVER PLATE THESE STEPS ILLUSTRATE THE o , ATTACHED WITH POP RIVETS REQUIREMENTS OUTLINED IN THE AISC a (030105) (1) PER CLEAT SPECIFICATION. THE ROTATION , , AT BOTTOM OF CONNECTION INDICATED IS ACCURATE FOR MOST^o —TENSION MEMBER BOLT DIAMETERS AND LENGTHS BUT IT IS :o j THE RESPONSIBILITY OF THE INSTALLER -" TRUSS TO MEET AISC REQUIREMENTS. COMPRESSION TUBESTE ONE: O WELDED UG TIGHT, WMARK PLATE WELDED TO RIDGE BEAM MATCH M 1/2"PLATE RIDGE BEAM w/ 3/8" FLG. PLT.--------- 3/8" PLATE Oi BOLT. HEX, 1-8X2 112 O (2) PLCS EACH CONNECTION ---------- �� 3/8" PLATE STEP TWO: 3/8" PLATE BOLT, HEX, 3/4-1OX2 THEN TURN BOLT/NUT PAST (2) PLCS EACH CONNECTION 1 SNUG TIGHT 1 /3 TURN TRUSS TAIL TRUSS O +� � T O n Z 3 Y K-100 COMPRESSION MEMBER CONNECTION T-100 R R BOLTS ARE A325 BOLTS AND TO BE INSTALLED BY THE ENSIONING METHOD AS SPECIFIED IN THE 13TH DIAMETER AND LARGER BOLTS. ANCHOR BOLTS NEED NOT BE TIGHTENED PAST SNUG TIGHT. 2. LOCAL JURISDICTIONS MAY REQUIRE AN INSPECTOR TO BE PRESENT TO WITNESS HARDWARE INSTALLATION AND INDEPENDENT TESTING. INSPECTION REQUIREMENTS SHOULD BE VERIFIED PRIOR TO STEEL ERECTION. 3. ERECTION OF THE FRAMING MEMBERS WILL REQUIRE THE MAIN COLUMNS TO BE PLUMB SQUARE AND TIGHTENED TO THE TRUSSES AND TENSION MEMBERS BEFORE INSTALLING THE PURLINS. PURLINS, IF REQUIRED, MUST BE PARALLEL TO THE EAVE BEAMS AND TENSION MEMBERS. 4. TOUCH-UP PAINT MUST BE APPLIED TO ALL EXPOSED BOLTS 8 NUTS. PERIODIC TOUCH-UP ATTHESE BOLTED CONNECTIONS IS REQUIRED. 5. UNLESS THE BUILDING HAS A FACTORY APPLIED POW DERCOAT, E-COAT - OR GALVANIZING, THE FRAME WILL BE PRIME PAINTED AND WILL BE REQUIRED TO BE FINISH PAINTED IN THE FIELD WITH ALL PAINT, MATERIALS AND LABOR NOT BY POUGON (PORTERCORP). REFER TO FINAL SALES ORDER. 6. PRIOR TO THE ERECTION OF SHELTER COMPONENTS, IT IS RECOMMENDED TO CHASE AND TAP STRUCTURAL HARDWARE. EVEN THOUGH POLIGON MAKES EVERY EFFORT TO PROTECT THE HARDWARE DURING THE PROCESS OF PRODUCTION, FINISH, AND SHIPPING, THE ON -SITE CHASING AND TAPPING OF THREADS IS ALWAYS GOOD POLICY. 7. TO PREVENT RUSTSTAINING OF FINISH, ALL METAL SHAVINGS MUST BE REMOVED AFTER INSTALLATION. ENSURE NO SHAVING ARE TRAPPED BETWEEN MEMBER SURFACES. 8$� Y o Ilk u.2 N n lIA 0 PURLIN CONNECTION COLUMN (1) COVER PLATE STRAP(7513 (1) ONE WAY2REW (030055) ANCHOR ACCESS COVER PLATE A-100 1 1 /4" ONE 171 O.C, REMOVE META OF U-CLIP CONNECTION NOTE: U-CLIP MUST BE ATTACHED TO TENSION MEMBER AS SHOWN PRIOR TO BUILDING ASSEMBLY. MEMBER . LD NOT D SEAM UC-100 J a Q 0 O 'r N OF 1"'. �'a, O w Z tt O Z ce Cn,^ 6 X < fl a1 l •J SHEET 4.1 4G! ME SEALED, TIE SEAL MMIES OKY TO EMT] (AND F DATION DESIGN V MPU US NLED W THN THESE DR .v S. w e G) �, a P Co C/ CL a 0 MR-500 SHEET 6.1 $ c to n m 4 < N N v �W � R n a W MR-100 SHEET 6 MR-600 SHEET 6.1 MR-300 < SHEET 6 MR-900 0 =O SHEET6.2 tHOFff4s, z w r c e O } 3� cHiiluTOrs 1� X LL 0 Ev _ civ- 5 O Eli 110. � ` LL A'yb 9F0 SHM v TNE5E 0iUV l 6ENE EK O nLY TO lIALlYHOG%UnjNO nI>IIGN.WJIUWlE) ' pTNNT81!UMWS MULTI -RIB NOTES: 8'- 9- 1'81/IV 12 8V 13/I6- 9/16- RLIN TENSION MEMBER THE DETAILS SHOWN ARE SUGGESTIONS OR GUIDELINES ON HOW TO ERECT THE SYSTEMS. THE INFORMATION SHOWN IS ACCURATE, BUT IT IS NOT INTENDED TO COVER ALL INSTANCES, BUILDING REQUIREMENTS, DESIGNS OR CODES. THE DETAILS MAY REQUIRE CHANGES OR REVISIONS DUE TO FIELD CONDITIONS. IT SHALL BE THE RESPONSIBILITY OF THE ERECTOR TO ENSURE THAT THE DETAILS MEET PARTICULAR BUILDING REQUIREMENTS AND TO ASSURE ADEQUATE WATER TIGHTNESS. THE ERECTOR SHOULD THOROUGHLY FAMILIARIZE HIMSELF/HERSELF WITH ALL ERECTION INSTRUCTIONS BEFORE STARTING WORK. THE PANELS SHOULD BE INSTALLED PLUMB, STRAIGHT, AND ACCURATELY TO THE ADJACENT WORK. FLASHING AND TRIM SHALL BE INSTALLED TRUE, AND IN PROPER ALIGNMENT, WITH ANY EXPOSED FASTENERS EQUALLY SPACED FOR THE BEST APPEARANCE. SEALANT SHALL BE FIELD APPLIED ON DRY, CLEAN SURFACES. SOME FIELD CUTTING AND FITTING OF PANELS AND FLASHING IS TO BE EXPECTED BY THE ERECTOR AND MINOR FIELD CORRECTIONS ARE A PART OF NORMAL ERECTION WORK. WORKMANSHIP SHALL BE OF THE BEST INDUSTRY STANDARDS AND INSTALLATION SHALL BE PERFORMED BY EXPERIENCED METAL CRAFTSMEN. METAL SHAVINGS FROM DRILLING OR INSTALLATION OF ROOF FASTENERS MUST BE CAREFULLY REMOVED FROM THE ROOF BY BRUSHING OR SWEEPING AT THE END OF EACH DAY DURING INSTALLATION. SHAVINGS LEFT ON THE ROOF WILL QUICKLY RUST AND STAIN THE ROOF FINISH. IDGE BEAM RIB PANEL ROOF G SHOFMq OZ w �`a Ssscs O . > CL o c< u ECI.'r, g g Go. : i251 ✓\ p Ssi ti; SHEET T ESEOMYn,.G! ME 6E 0, 111E fi A MP E!O,AY TO 5 m h N [a ce 10 ce 10 Q G! # 12-14 X 3/4" SELF DRILLING SCREW EACH SIDE OF RIB & CENTERED SPLICE CHANNEL (CENTER AT J-CHANNEL JOINT) a # 12-14 X 3/4" SELF DRILLING SCREW EACH RIB J-CHANNEL TRIM (INSTALL WITH 1/7' GAP FROM MR PANEL) POP RIVET (4) TOP & (4) # 12-13 X 3/4 DRILLING S( EAC #12-14 X 1-1/4 DRILLING S EACH SIDE MULTI RIB PANEL EXPANDING FOAM (TRIM FOAM SE FIT BETWEEN F CANNOTE OVER RIB AT E EAVE DETAIL a TI RIB PANEL TENSION MEMBER AND/ OR TAIL J-CHANNEL TRIM (INSTALL WITH I/2" GAP FROM MR PANEL) MULTI RIB PANEL MR-100 NOTE: ATTACH ROOF PEAK CAP TO RIBS & RIDGE CAP WITH #12-14x3/4"SELF DRILLING SCREW. (030000) PART DESCRIPTIONS: 030000 # 12-14x3/4" SELF DRILLING SCREW. 1210 ##-4 x l 1 /4" SELF DRILLING SCREW. �USE ONLY TO FASTEN ROOF AT HE RIDGE TO THE TRUSS OR RIDGE BEAM.) 030105 1 /8" POP RIVET. NOTE: ALL MATERIALS ARE CALLED OUT ON SHEETS 5.1. n :2 x =v J_ Q in z O U w z z O U TRUSS DETAIL MR-300 MULTI -RIB RIDGE CAPS a # 12-14 X 3/4" SELF DRILLING SCREW EACH RIB MULTI -RIB PANEL # 12-14 X 3/4" SEL DRILLING SCREY EACH SIDE OF RI ok RIDGE CAP # 12-14 x 1 1 /4" SELF (OVERLAP 6") DRILLING SCREW TEACH SIDE OF RIB OUTSIDE FOAM CLOSURE RIDGE DETAIL PURLIN DETAIL RIDGE BEAM AND/OR TAIL 0 E NOTE: ATTACH ROOF PEAK CAP TO RIBS & 0 a c U RIDGE CAP WITH # 12-14x3/4"SELF o ai DRILLING SCREW. (030000) � o PART DESCRIPTIONS: O i a= 12l4x3/4" # SELF DRILLING SCREW. 0300 214 # 1-x1 1 /4" SELF DRILLING o SCREW. a S k USE ONLY TO FASTEN ROOF AT (( THE RIDGE TO THE TRUSS OR RIDGE � � f BEAM.) Y_ iZ 030105 1/8"POP RIVET.• M c y 'n n p Q h N •• m ALL MATERIALS ARE CALLED OUT ON SHEETS 5.1. (sir N a E NOTE: ATTACH ROOF PEAK CAP TO RIBS 8 `.a u O e U HIP CAP RIDGE CAP WITH#12-14x3/4"SELF �' c DRILLING SCREW. (030000) PT ° MULTI -RIB PANEL a F MULTI RIB PANEL PART DESCRIPTIONS: a' 0 a ; wd a O #12�Ix3/4"SELF DRILLING SCREW. t 030030 t / SELF DRILLING @� a Y J CHANNEL TRIM (S4"x1 NLY FASTEN ROOF AT 7TO HEER DGE TO THE TRUSS OR RIDGE BEAM.( POP RIVETS--,-030105 R (9) PER CORNER 1/8" POP RIVET. c E•> J-CHANNELTRIM b a Lo J-CHANNEL CORNER TRIM N e � m J-CHANNEL CORNER TRIM ALL MATERIALS ARE CALLED i (FIELD CUT AND FOLD TAB UNDER OUT ON SHEETS 5.1. v ADJACENT PIECE CORNER DETAIL MR-900 _ i3E Lo a' a h uR o z O 4 U •�HOFA;�\ O Z EVPPS 1 a LL X O 5 O fs /OV L ti ' 7 SHEET Y(L�0i� K THESED WNGS ME SEED, THE SEAL M ES ONLY TO OULiMHO DDMPGNENTS vm fOUN lm DESIGN VM GMLQ DETM.EG W1 NTHESE pUWWS, CALCULATIONS FOR: POLIGON RAM 1SX24 MR MULTI RIB 2009 INTERNATIONAL BUILDING CODE BFILE COPY PREPARED UNDER THE CONTROLAND SUPERVISION OF: PORTERCORP 42Q1 IWMAWWE MOLLA ,M14UN (M)2B IW3 H OF 414ss'c= CHRMOPHER U O EVA, ca NI� 9./9 �s \1r ( poligon' Design Criteria Structural Engineering Notes Load Combinations Materials Structure Geometry Foundation Design Connection Design RISA Analysis Report Panel Data TABLE OF CONTENTS poligon• DESIGN CRITERIA ' GENERAL Building Code: See Cover Sheet Roof Slope ('): 18.43 4:12 NO _ Design Code: ASCE 7-05 ' Occupancy Category II Equivalent Roof Height 15.00 R DEAD LOAD Weight of Roofing System 2 psf ' Frame Dead Load Frame Self -Weight (See RIM Analysis Reporo LIVE LOAD ' Roof Live Load, L, 20 psf ASCE 7 Table 4-1 SNOW LOAD Ground Snow Load, p, 30.0 psf Importance Factor, I (Snow Loads) 1.0 ASCE 7 Table 7-4 Slope Factor, C. 1.0 ASCE 7 Fgunt 7-2 Thermal Factor, C, _ - - 1.2 ASCE 7 Table 74 Exposure Factor, C. 1.0 ASCE 7 Tabk 7-2 Flat Roof Snow Load, p r 25.2 psf ASCE 7 Section 7.3 ' Leeward Unbalanced Snow Load 30.0 psf ASCE 7 Section 7.0.1 WIND LOAD Basic Wind Speed, V 120 mph ASCE 7 Section 6.5.4 ' Exposure Category C ASCE 7 Section 6.5.6 Importance Factor, l (Wind Loads) 1.00 ASCE 7 Table 6-1 Gust Effect Factor, G . - - - 0.85 ASCE 7Sectiun 6.5.6 Velocity Pressure Exposure Coefficient, Ka 0.85 ASCE 7Table 6-3 ' Wind Directionality Factor, Ke 0.85 ASCE 7 Table 6-4 Topographic Factor, K„ 1.00 ASCE 7 Section 6.57 Velocity Pressure, q, .. -- 26.63 psf - ASCE 7 Section 6.5 10 ' Main Wind -Force Resisting System ASCE 7Sec6an 65.13 Component and Cladding Elements ASCE 7 Section 6.513 Open auftnp, Clear Wind Flew (Cn Item ASCE 7 Fig. 6/6A - 6-16D) Open eudoing, Clear W/nd Flow (Cn hom ASCE 7 Fig 6-19A - 6-19D) .. - Roof - Wind Direction Toward Root Away Fran Roof Load Case A B Zone 3 Cn: 229 -2.11 _ Y = 0 P (psf): - 51.88 -47.73 Cn: 1.10 0.01 Zone 2 Cn: 1.77 -1.63 -p (psf): - 24.90 -- 0.19 - p (PSI: 40.04 -36.93 Y = 180 Zone 1 Cn: 1.15 -1.05 ' Cn: . -0.17 -0.96 p (psf): 25.94 -23.87 P (psf): -3.87 -21.79 Y=90 Cn: 0.80 -0.50 P (psf): -18.11 -18.11 ' SEISMIC LOAD Analysis Procedure Equivalent Lateral Force Procedure ASCE 7 Section 128 Seismic Site Class - - D _ - ASCE 7 Section 11.4.2 Basic Seismic Force Resisting System steer Systems Not Spedncally Detaned For seismic Resistance ASCE 7 Table /22.1 ' Short Spectral Response Parameter, S, 0.55 1See Spectral Resonse Parameter, S, 0.13 Seismic Design Category C - ASCE 7 Section 11.0 Importance Factor, 1 1.00 ASCE 7 Table 11.5.1 ' Response Modification Coefficient, R 3.00 ASCE 7 Table 122.1 Redundancy Factor, p 1.00 ASCE 7 Table 1221 Overstrength Factor, 0. 3.00 ASCE 7 Table 122.1 Design Short Spectral Response Parameter, Sos 0.50 ASCE 7 Section 11.4.4 ' 1-Sec Design Spectral Resonse Parameter, So, 0.20 ASCE 7 Secbm 11.4.4 Seismic Response Coefficient, C, 0.17 ASCE 7 Seam 126.1 Effective Seismic Weight - 2.00 psf - ASCE 7Sectinn/2L2 Seismic Base Shear, V 0.33 psf ASCE 7 Section /26/ ' Seismic Load, E 0.33 psi ASCE 7 Section 124 Seismic Load with Overstrength Factor, Em 1.00 psf ASCE 7 Section /24 poligon' GENERAL NOTES STRUCTURAL ENGINEERING NOTES All field connections must be made with A325 High Strength bolts using the'Tumof-Nut Pretensioning' method of tightening as described in the latest AISC Manual. Loads applied to the structure may be greater than required for the project location. Actual structure dimensions may be smaller than shown In this document STRUCTURAL ANALYSIS NOTES RISA-3D structural analysis software was used to model the 3-D space frame. To reduce the amount of computer printout, the analysis results only show each member's controlling load case. Unless noted otherwise In the'RISA Analysis Repot, the roof deck was not utilized In the structural analysis to provide lateral support to the members. From the analysis, all member deflections and structural drift are within allowable limits. STRUCTURAL DESIGN NOTES End plates were designed by applying beam end forced to the edges of the plate and calculating the resulting prying moment at the edge of the bolt holes. In determining the prying moment it was assumed that the area of the plate between bolts was fixed. Ught gage members were designed In accordance with the latest edition of the AISC specifications and the AISI Cold -Formed Steel Design Manual. STRUCTURAL CONNECTION NOTES Bolt threads were assumed to not be excluded from the connections. poligon' LOAD COMBINATIONS ' Key Service (Unfactored) Abbreviation Description Number Description DL Dead Load 41 SERVICE DL Lr Roof Live Load 42 SERVICE Lr ' SL Snow Load 43 SERVICE SL USL Unbalanced Snow Load 44 SERVICE WLX (Uplift) WLX Wind Load (X-Direction) 45 SERVICE WLX (Down) WLZ Wind Load (Z-Direction) 46 SERVICE WLZ (Uplift) Min WLX 10 psf Minimum Wind Load (X-Direction) 47 SERVICE WLZ (Down) Min WLZ 10 psf Minimum Wind Load (Z-Direction) 48 SERVICE EX EX Seismic Load (X-Direction) 49 SERVICE EZ EZ Seismic Load (Z-Direction) 50 SERVICE EMX EMX Seismic Load (X-Direction) with Overstrength Factor 51 SERVICE EMZ EMZ Seismic Load (Z-Direction) with Overstrength Factor SDS Design Spectral Acceleration Parameter Allowable Stress Design (Factored) Strength Design (Factored) Number Description Number Description ' 9 DL 52 1.4xDL 10 DL+Lr 53 1.2xDL + 1.6xLr + 0.8xWLX (Uplift) 11 DL+SL 54 1.2xDL + 1.6xLr + 0.8xWLX (Down) 12 DL+USL 55 1.2xDL + 1.6xLr + 0.8xWLZ (Uplift) ' 13 0.6xDL + WLX (Uplift) 56 12xDL+1.6xLr+0.8xWLZ(Dawn) 14 DL+0.75xLr+0.75xWLX(Down) 57 1.2xDL+1.6xSL+0.8xWLX(Uprdt) 15 DL+0.75xSL+0.75xWLX(Down) 58 12xDL+1.6xSL+0.8W"(Down) 16 0.6xDL+WLZ (Upliift) 59 1.2xDL + 1.6xSL + 0.8xWLZ (Uplift) ' 17 DL + 0.75xLr + 0.75WAZ (Down) 60 1.2xDL + 1.6xSL + 0.8xWLZ (Down) 18 DL + 0.75xSL + 0.75xWLZ (Down) 61 1.2xDL+1.6xWLX(Upliift)+0.5xLr 19 0.601- + Min WLX 62 1.2xDL + 1.6xWLX (Down) + 0.5xLr 20 DL + 0.75xLr + 0.75xMin WLX 63 1.2xDL+1.6xWLZ(Uplift)+0.5xLr 21 DL + 0.75xSL + 0.75xMin WLX 64 1.2xDL + 1.6xWLZ (Down) + 0.5xLr 22 0.6xDL + Min WLZ 65 12xDL+1.6xWLX(Uplift)+0.5xSL 23 DL+0.75xLt+0.75xMinWLZ 66 12xDL + 1.6xWLX (Down) + 0.5xSL 24 DL + 0.75xSL + 0.75xMin WLZ 67 1.2xDL + 1.6xWLZ (Uplift) + 0.5xSL 25 (1.0+0.14xSDS)xDL+0.7xEX 68 1.2xDL + 1.6xWLZ (Down) + 0.5xSL 26(1.0+0.105xSDS)xDL+0.525xEX+0.75xLr 69 (1.2+0.2xSDS)xDL + 1.0xEX + 0.2xSL 27(1.0+0.105xSDS)xDL + 0.525xEX + 0.75xSL 70 (1.2+0.2xSDS)xDL+1.0xEZ+0.2xSL 28 (0.6-0.14xSDS)xDL+0.7xD( 71 0.9xDL+1.6xWLX(Uplift) 29 (1.0+0.14xSDS)xDL+0.7xEZ 72 0.9xDL+1.6xWLX(Down) 30(1.0+0.105xSDS)xDL + 0.525xEZ + 0.75xLr 73 0.9xDL + 1.6xWLZ (Uplift) 31(1.0+0.105xSDS)xDL + 0.525xEZ + 0.75xSL 74 0.9xDL+1.6xWLZ(Down) 32 (0.6-0.14xSDS)xDL + 0.7xEZ 75 (0.".2xSDS)xDL+1.0xEX ' 33 (1.0+0.14xSDS)xDL + 0.7xEMX 76 (0.9-0.2xSDS)xDL+1.0xEZ 34(1.0+0.105xSDS)xDL+0.525xEMX+0.75xLr 35(1.0+0.105xSDS)xDL + 0.525xEMX + 0.75xSL 36 (0.6-0.14xSDS)xDL+0.7xEMX ' 37 (1.0+0.14xSDS)xDL + 0.7xEMZ 38(1.0+0.105xSDS)xDL+0.525xEMZ+0.75xLr 39(1.0+0.105xSDS)xDL+0.525xEMZ+0.75xSL 40 (0.6-0.14xSDS)xDL + 0.7xEMZ 1 tes 1. Load combinations 1-0 am reserved for internal use. See RISA Analysis Report for more information. Z Seismic Loads with overstrengdt factors am only Included In the design where required by code. See member connection design for controlling bad combinations. 3. Load combinations am affective in as states that have adopted IBC as a base code. poligon' Column HSS6x6x3/16 Truss HSS6x4x1/8 Tension HSS6x4x1/8 Ridge _ - HSS5x3x1/8 Purlin HSS4x4x1/8 Truss Tail HSS4x4x1/8 Compression Tube HSS5x5x1/2 HSS Sections: ASTM A500 Gr. B Pipe Sections: ASTM A53 Gr. B RMT Sections: ASTM A519 Channel 6 Angle Sections: ASTM A36 Connection Plates: ASTM A36 Connections Bolts ASTM A325 Welding Process: Gas Metal Arc Welding Welding Electrode: E70xx MATERIALS I I 1 Joint Labels Member Labels Member Shapes Member Lengths STRUCTURE GEOMETRY Results for LC 9, DL m m Results for LC D, OL Results for LC 9, DL == w= w= w M M M M= w= M M= w= Member Length (Iq Displayed Results for LC g, DL poligone FOUNDATION DESIGN PINNED BASE Drilled Pier Allowable Actual Load Combination/Member 1 Bearing Pressure (Chapter 18 of the Building Code) 1500 psi 1187 psi 18 / Columnt OK 2 Uplift Check SF - 1.03 1367 Ibs 1329 Ibs 16 / Co1umn3 - OK 3 Sliding Check SF= 7.35 2630 Ibs 358 Ibs 15/Columnt OK 4 - Area of Reinforcement (AC: Chapter 10) _ 0.04 inz 2.26 inz 73 / Column3 OK _ 5 Bearing Pressure 6 Uplift Check 7 Sliding Check 8 Area of Reinforcement [1 1 1 - SF - 1.20 SF= 4.71 - (ACI Chapter 7) Allowable Actual Load Combination/Member 1599 lbs 13291bs 16/Column3 1687 Ibs 358 Ibs 15/Columnt 0.05 In 1.86 my 60 / Columnt Design Forces / Moments Check Load combination Member Fa(Aoa6 Rl Fy Rl Fz It) Mx R++I My lk+d Mz R-k+l 1 18 Columnt 3.73 .0.16 0.04 0.00 0.00 0.00 2 16 Column3 -1.33 0.03 0.02 0.00 0.00 0.00 3 15 Columnl 3.35 -0.36 0.11 0.00 0.00 0.00 4 73 Column3 -2-17 0.05 0.03 0.00 0.00 0.00 5 18 Columnt 3.73 -0.16 0.04 0.00 0.00 0.00 6 16 Column3 -1.33 0.03 0.02 0.00 0.00 0.00 7 15 Columnt 3.35 -0.36 0.11 0.00 0.00 0.00 B 60 Columnt 5.98 -0.29 0.11 0.Do 0.00 0.00 6 - 06 vertical bars (equally spaced) ' #4 ties horizontal C 12" O.C. w/ 2 ties in the top 5" � i I I 5ft i 11 1 3 - S5 horizontal bars (equally spaced) each way, top and bottom L_________________ I 1.5 R __________________ i 2 ft -'� �- 3.5It OK OK The foundation design contained herein is not site specific, but Is based on the presumptive allowable foundation pressures in Chapter 18 of the Building Code (Class 5 soif). The building official in the jurisdiction In which this structure is located may require a site specific geotechnical report or letter from a qualified local professional engineer attesting to whether the actual site conditions meet the assumptions Identified above. Drilled Pier Diameter (ft): 2.0 Spread Footing Width (ft): 3.5 Drilled Pier Depth (ft): 15.0 Spread Footing Thickness (ft): 1.5 fc (psi): 3000 Concrete Unit Weight (lb/ft): 145 FOUNDATION DESIGN -PINNED BASE E OK 1 poligona COLUMN BASE PLATE CONNECTION ' PINNED CONNECTION ' Base Plate Check: 7"x7"x112" Allowable Actual Load Combination I Member 1 Plate Size (AISC J8-1) 1.9 m2 38.5 in' 181 Column2 OK - 2 Plate Thickness (RISC PART 14) 0.18 in 0.50 in 16I Column3 OK 3 Concrete Bearing (AISCJB-1) .1020 psi 97 psi 18/Column2 OK ' 4 Weld Check (RISC J2-3) 278 kin 0.06 kin 16 / Column3 OK Anchor Bolt Check: (4) 1/2" A307 Anchors Allowable Actual Load Combination I Member 5 Tension r (ACI D5.1) 24.7 kip 2.2 kip 731 Column3 OK ' 6 Concrete Breakout (Act D5.2) 22.3 kip 2.2 kip 73 / Column3 OK 7 Concrete Pullout (ACI D5.3) 31.6 kip 22 kip 73 / Column3 OK 8 Sideface Blowout (ACI D5.4) WA NIA - Not Considered Per RD5.4 OK 9 Shear - (ACI D6.1) 12.8 kip 0.7 kip 661 Column3 OK ' -10 Shear Breakout - (Act D6.2) 120 kip 0.7 kip 661 Column3 OK 11 Shear Pryout (Act D6.3) 44.5 kip 0.7 kip 66/Column3 OK 12 Interaction - _. (Act RD.7) - 1.0 0.02 73 / Column3 OK [1 1 Design Forces / Moments ChKk Load Cofthaem Member Fx(Axial) 0d Fy Ik) Fx hl Mx d+i1 My Ik4nj Mt ik-M 1 18 Column2 3.73 -0.16 0.04 0.00 0.00 0.00 2 16 Column3 -1.33 0.03 0.02 0.00 0.00 0.00 3 18 Column2 3.73 -0.16 0.134 0.00 0.00 0.00 4 16 Column3 -1.33 0.03 0.02 0.00 0.00 0.00 5 73 Column3 -2.17 0.05 0.03 0.00 0.00 0.00 6 73 Column3 .2.17 0.05 0.03 0.00 0.00 0.00 7 73 Cdumn3 -217 0.05 0.03 D.00 0.00 0.00 8 x x x x x x x x 9 66 Column3 3.94 .0.56 -0.37 0.00 0.00 0.00 10 66 Column3 3.94 -0.56 -0.37 0.00 0.00 0.00 11 66 Column3 3.94 -0.56 -0.37 0.00 0.00 0.00 12 73 Column3 -2.17 005 003 0.00 0.00 000 B=r Anchor Bolt Diameter (in): 1rz Min. Embedment Depth (in): 6.D Concrete Cover From C of Bolt (in): 10.5 fc (psi): 3000 Base Plate Elevation Column Size: HSS6x6x3 Min. Base Plate Size: 7"xrxtrz^ Weld Size (in): 0.188 COLUMN BASE PLATE COIVNEC77ON- PINNED CONNECTION E OK poligon' TENSION MEMBER TO COLUMN 2 BOLTS ' Bolt Check: (2) 1" Diameter, A325 Bolts Allowable Actual Load Combination I Member ' 1 Shear AISC(J3-1) Rdo 18.8 kip 12.5 kip 181 Tension2 OK 2 Tension auowableparnl' AISC(J12) 11r/0 22.5 kip 11.3 kip 18/Tension2 'OK 3 Bearing AISC (J3-6b) FWD 15.6 kip 12.5 kip 18 / Tension2 OK , End Plate Check: 0.6" Thick Allowable Actual Load Combination / Member 4 Shear Yielding AISC(J4-3) WJO 40.7 kip 3.0 kip 18/Tension3 OK 5 Shear Rupture - - AISC (J44) FVQ 40.0 kip 3.0 kip 181 Tension3 OK , 6 Weld Check .•012s AISC(J2-3) R./0 1.9 kiplin 1.3 kip7m 18/Tension2 OK 7 Plate Thickness(4) 4Al i 0.31 in 0.50 In 1B/Tension2 OK 22W� , Design Forces / Moments Che Load combWtlon Member Fz(Ad.0 N Fy RI Fz Ikl Mt Ikanl My Ik4nI Mz N-Inl 1 18 Tension2 4.0 -1.3 -0.1 -0.3 4.5 - 55.2 2 18 Tension2 4o -1.3 .0A -0.3 -4.5 55.2 3 18 Tension2 -4-0 .1.3 -0.1 -0.3 4.5 55.2 4 18 Tension3 4.2 .0.4 0.0 0.0 .1.0 9.1 5 18 Tension3 4.2 -0.4 0.0 0.0 -1.0 9.1 6 18 Tension2 4.0 -1.3 -0.1 -0.3 4.5 55.2 7 18 Tension2 4.0 -1.3 -0.1 -0.3 -4 5 55.2 Member Height (in): 6 Member Width (in): 4 Member Thickness (in): 0.125 End Plate Weld Size (in): 0.125 z=-2.82 in I • I 125 in FIE � 3 in pi 6 in 3.5 in Fbb 3 in <- 1.25 in F Wp = 5.65 147-1. ."r•. Number of Bolts: 2 Bolt Diameter (in): 1.000 End Plate Thickness (in): 0.500 Flange Plate Thickness (in): 0.375 TENSION MEMBER TO COLUMN-2 BOLTS E OK 1 1 1 1 1 1 poligore TRUSS TO COLUMN 2 BOLTS Bolt Check: (2) 0.75" Diameter, A325 Bolts - Allowable Actual Load Combination / Member 1 Shear AISC (J3-1) RalO 10.6 kip 2.0 lup 151 Truss3 OK 2 Tension AISC(J3-1) R�JO 19.9 kip 4.4 kip 131 Truss3 OK 3 Bearing AISC(J3-6b) P.Wn 17.8 kip 2.0 kip 151 Twss3 OK End Plate Check: 0.376" Thick Allowable Actual Load Combination /Member 4 Shear Melding AISC(J4-3) RrM 33.3 kip 1.6 kip 181 Trusst OK 5 Shear Rupture - AISC (J44) R,Jn 29.6 kip 1.6 kip _ 181 Trussl OK 6 Weld Check w-0.123- AISC (J2-3) Relit 1.9 kiptin 0.6 kip/in 151 Truss2 OK 46f,i 7 Plate Thickness(t,) 22W, 0.29 in 0.381n 131Truss3 OK Design Forces / Moments Check LOW Combination Member Fx (Adal) N FY Ik) Fz Ik) Mx Panl My Ikon) Mz Ikdnl 1 15 Truss3 6.0 0.0 0.0 4.1 .2.4 2.6 2 13 Truss3 -1.5 0.0 0.1 2.0 -3.9 12.0 3 15 Truss3 SO 0.0 0.0 4.1 -2.4 2S 4 18 Trusst 6.2 0.2 0.1 .3.9 -1.3 -10.2 5 18 Trusst 6.2 0.2 0.1 -3.9 -1.3 -10.2 6 15 Truss2 5.6 0.1 0.0 -1.2 3.1 -17.9 7 1 13 1 Truss3 -1.5 1 0.0 0.1 2.0 1 -3.9 1 12.0 12 2 831 HSS6X4X0.125 B B • 13.26' Member Height (in): 6 Member Width (in): 4 Member Thickness (in): 0.125 End Plate Weld Size (in): 0.125 x = 2 In 1.5 3.08 in 16 in 3.16 in EFR a MI) EFeb 3.08 in 1.5 in Number Bolts: Bolt Diameter (in): 0.750 End Plate Thickness (in): 0.375 Flange Plate Thickness (in): 0.250 TRUSS TO COLUMN -2BOLTS E OK poligona TRUSS TO COMPRESSION MEMBER 2 BOLTS Bolt Check: (2) 0.75" Diameter, A325 Bolts Allowable Actual Load Combination / Member 1 Shear AISC(J3.1) 11,10 10.6 kip 1.4 kip 151 Truss3 OK 2 Tension AISC(J3-1) R,10 19.9 kip 2.1 kip 161 Trussl OK 3 Bearing AISC(J3-0b) FWD 17.8 kip 1.4 kip 151 Truss3 OK End Plate Check: 0.375" Thick Allowable Actual Load Combination /Member 4 Shear Yielding AISC (J4-3) Ra/0 33.3 kip 0.5 kip 151 Truss3 OK- 5 Shear Rupture AISC (J44) Via 29.6 kip 0.5 kip 151 Truss3 OK 6 Weld Check w"o. 125' AISC(J2.3) RwD 1.9 kiprn 0.3 kipliin 18/Truss4 OK 7 Plate Thickness lip) _ 4Mrc 22W, 0.21 in 0.38 in 161 Trusst OK Design Forces / Moments Check Load Comdnalbn MaMw N F. (lWeqr0A Fz h1 Mx lkirl My 8,+n1 Mz li 1 15 Truss3 2.5 0.0 4.1 -0.1 2.7 2 16 Trusst -1.1 0.0 -0.6 1.1 -5.7 3 15 Truss3 2.5 0.0 4.1 -0.1 2.7 4 15 Twss3 2.5 0.0 4.1 -0.1 2.7 5 15 Tmss3 2.5 0.0 4.1 .0.1 2.7 6 18 Truss4 2.8 0.0 0.0 -1.0 10.2 7 16 Trussl -1.1 1 0.0 1 -0.6 1 1.1 1 .5.7 12 2 831 HSSSX4X0.125 6 = 13.26' x=2in Wp=41n Lp= 6.16 in 1.5 3.16 1.5 End Plate Section Member Height (in): 6 1 Number of Bolts: 2 Member Width (in): 4 Bolt Diameter (in): 0.750 Member Thickness (in): 0.125 End Plate Thickness (in): 0.375 End Plate Weld Size (in): 0.125 Flange Plate Thickness (in): NONE 3.08 N ' W lit 3.08 in 1 TRUSS TO COMPRESSION MEMBER-2 BOLTS E OK IJ 1 1 1 poligona RIDGE BEAM TO COMPRESSION TUBE 2 BOLTS Bolt Check: (2) 0.75" Diameter, A326 Bolts Allowable Actual Load Combination I Member 1 Shear AISC (J3-1) R"10 10.6 kip 0.3 kip 161 Ndget OK 2 Tension _ AISC(J3-1) RWO 19.9 kip 3.5 kip IGIRidgel OK 3 Bearing AISC (J3-6b) RrJO 13.8 kip 0.3 kip 161 Ridgel OK End Plate Check: 0.376" Thick Allowable Actual Load Combination I Member 4 Shear Melding AISC (J4-3) F?.M 27.0 kip 0.4 kip 151 Ridgel - OK 5 _ Shear Rupture AISC (J44) ReIO 22.0 kip 0.4 kip 151 Ridgel OK 6 Weld Check w"0.125- AISC (12-3) R"IO 1.9 koriin 0.5 kipliin 161 Ridgel OK 46fpa 7 Plate Thickness(tp) - - zzw, 0.27 In 0.38 in 161 Ridgel OK 9ETilr -u Design Forces / Moments Check Load Combination Member Fa (Aoal) Rl FY RI Fz PI MIX Rani MY R4„1 Mz R-hl 1 16 Rdgel -1.5 -0.3 0.0 0.0 0.1 -9A 2 16 Rdgel -1.5 -0.3 0.0 0.0 0.1 -9.1 3 16 Ridgel -1.5 -0.3 0.0 0.0 0.1 .9.1 4 15 Ridgel 3.5 0.4 0.0 -0.1 -0.9 6.2 5 15 Rdgel 3.5 0.4 0.0 -0.1 49 6.2 6 16 Rdgel .1.5 .0.3 0.0 0.0 0.1 -9.1 7 1 16 1 Ridgel 1 .1.5 -0O3 1 0.0 1 0.0 1 0.1 1 -9.1 HSS5X3X0.125 ( .,.TTTiC�ni[], 4 -Sim x=1.51n I • I _ 125 N Lp= 5 in 251n 1.25 in Ixs�hsr��st-s+m FS pl 125 in `- I( M,) 25 in Member Height (in): 5 Number Bolts: Member Width (in): 3 Bolt Diameter (in): 0.750 Member Thickness (in): 0.125 End Plate Thickness (in): 0.375 End Plate Weld Size (in): 0.125 Flange Plate Thickness (in): NONE WELDED CONNECTION IS PERMITTED RIDGE BEAM TO COMPRESSION "E. 2 BOLTS £ OK poligon' PURLIN CONNECTION ONE-SIDED ' Top Flange Checks: (3) 14-14 Screws Allowable Actual Load Combination I Member ' 1 Shear (3 of the screws) 2573 lb 801 lb 16 / Punml OK 2 Tension (none of the screws) - 0 lb 0 lb - Na OK 3 Shear Yielding (plate) AISC (J4-3) RWD 14546 lb 801 lb 16 / Purlint OK 4 Shear Rupture (plate) - AISC (J4-4) R,JO 16211 lb 801 lb 16 / Purtinl OK ' Side Flange Checks: (4) 14-14 Strews Allowable Actual Load Combination I Member 5 Shear (4 of the screws) 3431 lb 2493 lb 18 / Punm4 OK 6 Tension (none of the screws) _ - 0 lb 0 lb Na OK , 7 Shear Yielding (plate) AISC (J4-3) RH/O 6025 lb 2493 lb 18 / Purtin4 OK 8 Shear Rupture (plate). - - AISC (J44) Re/0 5450 ib 2493 lb 18 / Purlin4 OK Weld Check: 0.125" Fillet Weld Allowable Actual Load Combination I Member ' 9 Weld Check RISC (J2-3) Rn/0 1.51 klplm 0.13 kiplm 18 / Pudin4 OK Design Forces / Moments Check Load Combinakn Merri6er Fx (Adat) N FY Rl F: hl Mx Ik+q My lk4nl Mz R-kV 1 16 Punmt .0.8 0.0 0.8 O.0 0.0 0.0 2 Na Na Na Na Na No Na Na 3 16 Purhnt -0.8 0.0 0.8 0.0 0.0 0.0 4 16 Purlml -0.8 0.0 0.8 0.0 0.0 0.0 5 18 Purlin4 1.6 0.7 -1.8 0.0 0.0 0.0 6 Na Na Na Na Na Na Na Na 7 18 Pvlin4 1.6 0.7 -1.8 0.0 all 0.0 B 1B Pralin4 1.6 0.7 •1.8 0.0 ao 0.0 9 18 Purllnb 1 1.6 1 0.7 -1.8 0.0 0.0 0.0 s"L4' 'PU,M m oppome sire of buss nor shown lb, Gadty ' Sa goangy b akelcbea abmv may not la6ecf actual mquements Member Height (in): 4 Member Width (in): 4 Member Thickness (in): 0.125 End Plate Weld Size (in): 1/8 lark-IVEM •r Sheet Metal Thickness: 12 gage 0. 1046 in Screw Size: 14-14 0030026 Screw Quantity (Top): 3 Screw Quantity (Side): 4 PUR(/N CONNEC77ON-ONESIDED £ OK 1 [1 1 1 Poligone TAIL CONNECTION 2 BOLTS Bolt Check: (2) 0.625" Diameter, A325 Bolts Allowable Actual Load Combination I Member 1 Shear AISC(d3-1) Rw/O 7.4 kip 0.2 kip 12 / Trussta112 OK 2 Tension AISC(J3-1) ReIO 13.8 kip 0.9 kip 151 Trusstailil OK 3 Bearing AISC(.13£b) P,/O 14.8 kip 0.2 kip 12/TrusstaU OK End Plate Check: 0.375" Thick Allowable Actual Load Combination / Member - 4 Shear Yielding AISC(.14-3) RWO 22.2 kip 0.2 kip 181 Trusstaill OK 5 Shear Rupture - - AISC (.14-4) 11iJ0 17.8 kip - 0.2 kip 18 / Twsstailt OK 6 Weld Check w"al25' AISC (.12-3) Rr/O 1.9 kiplm 0.1 kip/n 151 TrusstaiA OK 4Mrc 7 Plate Thickness(tp) 22W, 0.13 in 0.381n 151 Trusstai14 OK - Design Forces / Moments Check Load combination Member Fx (Adao Ikl FT Ikl Fit R] Mx Ik-til Mr U-FI Mz P-i.1 1 12 Trusstail2 0.0 .0.2 0.0 0.0 0.0 1.8 2 15 Trusstail4 0.0 -0.2 0.0 0.0 0.0 2.1 3 12 Trusstail2 0.0 -0.2 0.0 0.0 0.0 1.8 4 18 Trusstaill 0.0 .0.2 0.0 0.0 0.0 2.1 5 18 Trusstaill 0.0 -0.2 0.0 0.0 0.0 2.1 6 15 Trusstail4 0.0 .02 0.0 Oo 0.0 2.1 7 1 15 1 Tmsstail4 0.0 1 -0.2 1 Co 1 0.0 1 0.0 2.1 12 283� HSS4X4XO.125 Minimum Size a 8 = 13.26' Connection Elevation Member Height (in): 4 Member Width (iin): 4 Member Thickness (in): 0.125 End Plate Weld Size [in): 0.125 fix= 21n x I 1.25 in Fm 2.05 in Fx, pl Lp= 4.10 in 1.61 in F- M; p Ebb 2.05 In 1.25 in Wp=41n Number Bolts: Bolt Diameter (in): 0.625 End Plate Thickness (in): 0.375 Flange Plate Thickness (in): NONE TAIL CONNECTION-2 BOLTS E OK 1 CC " PORTERCORP Joe Hu lv Moth Na R Load CombinatIons (Continued) C as BYE u . e.M.alaalal fa �767 - al fa�sfafa aal • . �ai"N���staa�tataa�� r47 �alalalalal�alalal� Joint Boundary Condidons Hot Rolled Steel Section Sets r"x ... en , Troe anBa �alr.H en. psnso EelrA6� Ttr; PM1rl"j—i Aeap or.e oe $IiA1 H555HBSSx7v2�Beem�T�BE Ba B Gr eB 0p MOO As00 GN8 DR7 .723 177 2T5 a03 802 FOnIn HI SSl;lil �S/x�T Beem_ eemT..BE I lUtiE ASae Gr.e pR1 1.77 N !.1 B91 B Tmsa TeA J�sBBG,mj—pR1 1.74.1� Member Prfmary Data IVm ASOeG b umn Gun B AS GOb u ohrJR V^ B ASOO Gr.e d Iwn Nam B Aeoo Gr.ee Is Beom BeamB VO Asao Gr.e R peN5 _ NZ TW I A5 G,44 13 rYRs B upI Beem_JUBE Beam A500 Gr.e !p is— VB MX Gr48 fl Nsstail aI Too VB Ae00 Gr Nl Beam TUDE,_—AS Grb mae1e11 1 ! me al Beam B a Gr.e R aa(ailN13 N12 TivaiTo Be0 B A oGrb IE IEp Beem UB Asao cr.e R _7, MOO Gr 45 11 Ten.icm2 I N I N12 Tan io Beam B ASoa ar..a µ B A500G u melon 9 enaiG Bee B ASOp cr.N B n P]OQ .,..P Mn e B Asoo G,.b A opar.e e V Aw G,46 Member Advanced Data ORPRISA Joe =e. PO0. ERCORP MO NMee Member Advanced Data lContlnuedl CLe w BYE a .�eL�Rlaaa•aa�aaaalaal�faaa� rfi aaalaaalaaaaaalaa� SMNM to ��tata� SMMW • �i a�a�aa�a�aa�raia�a� ie�rr�aa�aaaraaaazfta��a�aa�rftaa m a��aa��aaa�ax�a�a� i�7 �ar0•����r aa�aaar�aa�aaaaa�a� : : a�a�a�a�aaa�cr��a� i ������� c.r•. .ate Hot Rolled Steel Desfnn Parameters rTt—�LT ����•���Tec[Od-mama mt_T eaVm� �wT TT :1 "MMYr.NONE nnrt•rrt issa��e�sasa���rr� rr- araaaaaa�aaaaa E 14 i 4'71ifl�aa�a�aaalaa�a� ""MUTT" _� ow arin'a-trs aWMWM M aaI�RRl77� Hot Rolled Steel Pmyertfes RISA-3D Vm*m 12.0.0 IS:\..l..l..\_1551753 µ l6M4MR 2 20 30_1211_IBCOB_C_/LCF51255.rNppe! C.mOup PORT RCORP Joe IFYnO.r M00•I N.m• CM "By_ Envelooe AISC 130(360-051: ASD Sfeel Code Checke ymA.r 5sa eLa.Os twm tc sMr_l��_P�N4.1°.°e bo� T Hssem.. 50 0. 4 4993@. 9.92 22.01 MO-1-2 ten -i 09 @ 1 0 i 1 M01I taleHI-lb wmn ssem_ 0 .5 4 9.62 =012167e ysl Isss.�. lte v 18 1.228 61.42t 73,197 115e33 1.116HI-lb wsoZ HSMA 715 2 1156331O [4a14 H556.4.. 5 aLI5 V 15 51,228, -OL42L 73,197 115633 tell aa1 @ 71e 2 115633 t atHI-lb wa• sad. 7 em V l@ 42.16 42169 4U 40,754 B 05.792- 05.2@ 10 rv.w. ISsad. f Q14 s It rv.n. swa __P?o 94 29D6 ALI% 10,7 V9 05Z92 @ B 2 9aa wn.. SU-4 -n v 15421694QB Udgol 15554. 7 a @ ] 40.Z5 IL501 84 tmev gee 22M - 9 14 .nsu... Hssed.. w.a_. used. 4 i .?_OSB L}i 116633 D71 •..b. ase.a.. 2 115e33 2'B - •ma... ssed_ Z @ ,� Li . 9 - 115533 101 sad.... 6 L2Z 18y @ 1.1.1 _ 1 fin2 ssw. 7.071 0 i 2. B 4U5 1 579 BS B Ojq 01 vae ite HSSId.. 2 @ 1 �yH H551d.. @ 5 1.115 Materiel Takeoff �p .1•n� I. I M� I e _� I W�yI.I� l.�teN00 W I gym MR es a " ��11111V-Tn� 10Sh3C V.. 12.0.0 IS:L..S.A_t..L..V1753 R 16X2/MR 2_20 30 120_IBCD9_C_A�CF51255.rAg9e5 McELROY METAL CORPORATE OFFICE • P.O. BOX 1148 • SHREVEPORT, LA 71163.1148 • (318) 747.8000 • FAX (318) 747.8029 'tE�;a N11 C,A1 'W EMNI Issue Date : Jane 1, 2006 No. 07-232-06 Multi -Rib • r ' TL 36' [DV9t4GE 1 1 1 t I FY • WEIGHT V, P, •,. P. w TOP IN COMPRESSION L, S. M• BOTTOM IN COMPRESSION 1. S. M• GAUGE (KSI) (PSF) Idp/1L IbS/1L bs7R M.,At 8n.'OL kbp-IlJIL (In-47IL) (I1.sIM1.) leap-In1R 24 500 1.14 0-9057 223.34 371.49 0.0527 0.0576 1.7233 0.0327 O.OSaJ L626T 1. Sodw 11101011105 am olQ2ated n agnrdmoe.it1 to 2001 AIR With 4. te fob deeemn delermnatlpd Amerlon Smcfficafion to 9r Design ot Cd6FOImed Sleet Shama Mambas. I Se is for bnl9i9 2. Va S be uo•yse naaz S. W le to allowable berating nwnmL ]. Pal Ih alo.yla bad fa web nppnD on and tntolor ssppor 7. AS valued am for we foot or parse wllA Allowable Uniform Loads (PSF) Span Tree LDid TYoo S 150 100 250 3m 150 400 450 an In Feet 500 550 600 650 ID] 750 600 850 900 Palle Wnd S10 297 193 127 W 71 55 45 77 31 27 D 2D 17 15 14 Neoolw Wnd 481 271 173 120 Be at S] 43 75 >0 25 22 19 15 15 17 Singe IAYe S10 297 193 127 93 71 55 45 77 31 27 77 70 17 15 /4 Delec1m M119) 13M 571 292 169 1m 71 50 36 27 21 16 13 10 t 7 5 Duemn M410 1015 428 I19 t28 79 Sl 37 17 20 15 12 9 t 8 S 4 Pml%s YTed al 253 166 115 86 65 •3 42 35 29 25 22 19 15 U 13 Metal" Whd 451 266 175 127 91 70 55 45 37 31 26 2] 70 17 15 14 Ian Wa 471 25] 166 116 86 65 52 42 35 29 25 22 19 18 /4 17 Dmettm MaDl 2651 1118 572 331 2D0 139 93 71 53 41 32 26 21 17 14 12 Dds%1m M40) 1988 t38 4H 24{ rite 104 77 53 40 31 1 24 19 15 1 13 10 9 Padbo V/nd 516 3179 2W 1" 107 82 65 53 44 37 31 27 23 21 IS -16-_ Neprow Wind 08 324 214 152 113 87 59 55 45 39 32 29 75 22 19 17 )fin lie 316 309 201 1N 107 82 65 53 44 37 31 n 27 21 18 16 Deffecom (Lq9D) 20T7 A76 448 259 163 109 75 55 42 32 25 20 16 17 11 9 wctn(Ut40) 1557 657 116 04 122 22 51 42 31 24 1 19 1 15 12 1 10 8 7 3anwe"d 489 791 191 135 10D T7 61 49 41 34 29 25 22 19 17 15 4agalw Wnd $10 7D5 2DI 142 105 a 64 12 4] 36 31 23 20 18 16 4�n lie 489 291 191 135 1O0 7-761 49 41 34 29 t2l 22 19 17 15 Dadec9m MOD) 7201 910 476 Z/S 177 116 tt 59 44 ]• 27 17 14 II 10 Drsadm (1n4O) 1 1653 697 357 216 130 87 51 44 1 33 25 20 16 13 10 9 7 t4p16. LAdbwSbil0, 10, bads" load won guy soon lmgOss. I Posters YAM I warm premium and I NOT boaased by 23 V311, ' 1 Negative Wad I wind s,am a upft and is NOT baeaed b7 331/3%. 4 Line Is 8e assemble we or sro , load. S Detection (UISO) I the 910.8ble bad tad hits IN Rmas de0emn to 11180 able order pairs# or we bad. 67DeleC11011 240) I Oe asbwable bad Bat lants Me owners Gideon 10L1240 while order pabtrs a war bad. . Tle.eg tofne peel la NOT Sun deducted ton to alouwEle bode. ' l Postw Wnd Negal"Wad, and Uw Load vabu am inled to onbbad Slur 8Snding ling Eat C311-1 of McAISI Soosteodo - 9 Posters Wad and Uve Lood•awes we bated by web [rippling icing a bearing lengdl orr. 10. Web aVpsslg vyues am daseoired using a ado of be araam bad sal wls wwDrwd b7 sra tip tangos of h scln. ' CORPORATE OFFICE SHREVEPORT, LOUISIANA 1 MIDWESTDIVISION • CLINTON,IL SOUTHEAST DIVISION • PEACHTREE CITY, GA WESTERN DIVISION • ADELANTO,CA NORTHEAST DIVISION • WINCHESTER.VA SOUTHWESTDIVISION • BOSSIERCITY,LA BLUEGRASS DIVISION • LEVOSPORT, KY WEST TEXAS DIVISION • MERKEL, TX GREAT LAKES DIVISION • MARSHALL, MI ` 32 0 yoyC BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. Towi1 oF1'annouth Building Departrurnt 1146 Route 28 . Yarmouth. NIA 026644192 Tel: 508.398-2231 exL 1261 Fax 50&398-0836 ¢e■Use Only M Planning Board Information Type Assessors Department Intomution: ad Permit No. ate Date �Map Permit Fee IN —/ Recording Date New Deposit Rec'd. S C\ Date _ Pan Na. 1.4 Property Dimensions: Net Due $ Other LWArea(so frontage (tt) Lot Coverage This Section for Office Use Only Buildin rmit umber. I Date I ued: C�k�z Certificate of Occupancy Signature: BuildN Official Due is is not required 1.1 Property Addreast ' 12 Zoning Information: 3r a1 Ar , Zo ing DistrictProposed Use 1.3 Building setbacks (ft) Front Yard Side Yards Rear Yard Required I Provided Required I Provided I Required I Provided I A Vfator Supply (eL0.L a. 40. S 541 11.5 Flood Zorn Public Private Zone: Section 2 - Property Ownership/Authorized A en1 1,�kvnor of R oe Name (pri SionaNre Teteohnne Name (print) Signature Telephone Section 3 - Constnrdion Services 3.1 Ucensod Construction Supervisors Address BFE Mailirg Address: so£3- Fa: 192014 Not Applicable t License Nurnber Date t o14 OVER Company Namo Address signature Telephone 4- 152 S 25C ==720 Regisbadon Number Espfratioi Date Workers Compensation insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit win result in the denial of the issuance of the building permit. . Affidavit Attached Yes .......... No .......... Section 5 - Professional Design and Construction Services - for Buildings and Structures Subject to Constriction Control Pursuant to 780 CMR 116 (containing more than 35.000 c.f. of enclosed space) 5.1 Not Mproabla ❑ Name (Reglsttranth Registration Number Expiation Data Name Ana et Resporalbairy Address Peomaeen NurEw Address Name Address General Contractor Company Name Person Responsible for Construction Address Regis neon NWOW Registration Data ww applicable O 2 of 4 Section 6 - Description of Proposed Work (check all appkcable) New Constructi on ❑ (tor maniple famiy Dory) Na. of Bedrooms (for munipie family only) No. of Bathrooms Existing Bldg. ❑ I Repair(s) ❑ I Afterations ❑ 1 Addition ❑ AccessoryBldg. ❑ Type Demolition Other Specify: Brief fD/es'cription of Proposed Work: n 8 Balding Height and Area Builmng Area NunEer of floors or stake Floor Area per Floor (sf) Total Area All Floors Total Height (R) Section 9 - STRUC Independent Stnuckiral SECTION 10a OV EER REVIEW (78C Shx:hjral Peer Review 101T e.I0l1T919;l 110 Yes ... No .-..-- as Owner of the subject property. hereby authori . ' ��. r1az 1 PU I N—, to act on my be all tiers relative to work authorized by this building permit application. Si hue of Owner !�^� Date 3 of 4 OVER I, , as Owner/Authorized Agent hereby declare that the statements and Information on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date Section 11 • ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be tvmpleted by permit ap cant 1. Building ,5 Ao 0 (? 2 Electrical 3. Plumbing / Gas e. Madnanical (MAC) S. Fire Protection a.Total .(t•2♦3•4+5) 7. TOW Spare FL lbw. Drew a aeemnl Check Below ❑ Conservation -Commission Firing (it applicable) ❑ Old Kings Highway 6 Historical Commission approval (if applicable) 4 of I1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 'fir www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AvOcant Information Please Print Legibly Name Address: Phone Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ 1 am a employer with • 4. ❑ I am a general contractor and I 6. ❑ New construction employees (fall and/or part-time' have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling ship and have no employees 'these sub -contactors have S. ❑ Demolition working for me in any capacity. employees and have workers' m [No workers' comp. insurance comp. insurance.t 9. ❑ Building addition required:] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their l LO Plumbing repairs or additions myself [No worker' comp. right of exemption per MGL 12.0 Roof repairs ftmz = ] t c. 152, § 1(4), and we have no 3a. ❑ I am a homeowner acting as a employees. [No workers' 13.0 Other general contractor (refer to #4). comp insurance require&] OAny sppli®t that eheda box #1 t A abo fill am the section below adoring their a& scompentadodtorwy tafatmtod • a.,.,�.,....w ..mcy m ammo au ewer am urea sae On"' eonoeeoon most aatrmft a new at5aavit indtotioa such. tr-ontraeeon that check this bol mart aaadwd an addtiaosl shed showing dw name of iha sub-emmerm and mu whether or ant those euudn bave employees. If the nib-emonsetao have employe; may tma pmTUk ttew wmYa' comp. toffy oolp� I an an anployer that fs provMMg workers' compensation imuraeee for any employees Below Is the po&7 andJob site fnformatdon. Insurance Cc %op-14VIC Policy # or Self -ins. Lic # C�—�0038 —�[� Expiration Date: ! Jr 15 Job Site Address: ��J�T f{r G . Y _r City/Stateaip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiation date). Failure to secure coverage as required under Section 25A of MGL c.152 can Lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $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 hoeby cerdi� under the *Ins and penalties of pciary that the 6rformadon provided above Ig trot and coo I I— QffleW ass only. Do not write in dds area, to Be eomp&-Md by city or town ofJlclaL City or Town: Permit/Llcense Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cityfrown Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone #: Information and Instructions Mmuhust m Ckneral Lave chapter 152 tequim all cmploydra to provide wodoe<a' compcnudon foi their empk7cca. ' Putsuaa to this statute, an sap&yw is defined ace ' —eves paaaa m 6g sariee of aood==da soy eaet< d ofhice cxpren a Implied. Oral of wrtttm." .' An rep& yw is de..fiwd. n "m tit us dM co�hoa a Otha k1d ca ft or soy two of muse of the ii , i e� in a joiat � and ........'o tht to ofa�dezza Cd COPiOya. Q tbIll recei►a er trustee of as i pat zmb* i»odgdm er Other kptl suety. cmpk.,"'o gcpbyeeL Hawnw dw awlna of a dwelling BOOR laying not tmB thin thm tpertmmb and who resides theteg at the of the dwelling hours of aootha who empin" Mmm to do miatmaocR COW ettctioa oc repay wmk Oa such dwtMq bom or on the peon& a bmidiag Muttmame tl 1 shall tot became of sock employment be deemed to bt m emplaW MGL chapter 1SZ 125c(O ew states that "rnry stab K beat lksstd agssty 1W wlthhesd the Issaaaew n reawal of a skean w parmk to eperab ■ badmov or to eanairset buildings In the mmeaw""ll fir It" applicant wM hm not pcodoatii secri table evldesm of ampIIsaa with the brows m uncap regmk"V Additionally. hMGL chaPW LA 12XM state `Neither the cow nx say of its pc&dieal subdiviskma shall eats fain nay eo *ad fac the paformaaet of public wadt until seeeptable erideaee of ecmPliaom with the bamwaco requ¢emmt• of this chaptrs have bees pstsealtd to the enoeactittg a therity.0 Appliaaat P1em tID eat the wad= eoagmaatim affidavit =Wletrly. by checking tha bam that apply to yoex situation nod, It n 1. snppty mb.emttaebr(s) nsme(s). sddteaa(m) and phoor a®ba(s) along with chair eau5ate(s) of saasata= Limited Lbbiltty compmiea (LLC) a T hChed Lta aq PUMMldP (LLn with no empb7'm other than the memI or, - am not regaucd to ca "woaksa' compensation lasuoaee. if m LLC or UP don have emplo)ee; a policy is re I ; *lie adrsaed that this afddarit may be submitted m the Dqm mad of bdortkl Aa3dear for ens& =dcn of maa<meo coverage Ain bo saw to s1p and dab the xmdavtL The affidavit should be ret►amed m the city at town that the application six the painit of lieemat is bring mgoetta I we the Depectumt of Dias Arsldenb. Should you have any goes iom rea 9; the law er if you m tegaQcd to obtain a war compeass-1 policy, pica" all tho Depatmen at the amber listed below Set iosQed emapeain should eats their City or Taeva Offieiai Pkace be we that the affidavit is caagleb and painted legibly. The Dep mocat bn provided a span at the botlos of the affidavit far you to ion oat era the .veal the office of favestip !ions hce to canted you regadiag the spPNaat Pkaae be sore to !III m &a Pcrni0k=wameba which will be used n a eefaenee mzcb>~ in addstitim an appBcant that ®R submit tmhfPL pccmWB=on applicadom In any gives yew. Head only submit ooa affidavit mdka0ng !natal Polley tnlbr�tiaa (if tteeasaey) mi uatkvr'lob Sib Addees" the aPpliaat should wri v %H lo=d= sweaty a tow or A copy of the affidavit dot has bees officially stamped or wed by the city or tours say be provided to the appIicad tie proof fist a valid affidavit era oa ffio liar ttt = pe®tr ae Iinemea A aw affidavit nmt be MW oat eack year. Whoa a home owner oc eittaa Is obtaining a Ikenme a patnit not mkbd m asy baafttes er comonesal venesa (Le. a dog fauns or peamt to bum leave cm) said person is NOT tegosed to enmpkb this affidavit. The Office of fanst pdm would Mite thank you in ad. for yam coopmdm and should you have any quatiOos. pkace do ant hesitrte to give as a a1L Ilse Department's addmu telephom and fits monI Thu comet awealth of MassWj=tts Dcputm- of Wtistlial Accident OfEa of IavatlpWas 600 Washington Street Boston. MA 02111 TeL Al 617-7274900 end 406 or 1-877-NMSAFE Revised 11-22-16 Fax 0 617-727-7749 www.m=gov/dia {� � • o R•s o O TOWN OF YARMOUTH BUILDING DEPARTMENT PLEASE PRINT. Job Location:_ CONSTRUCTION SUPERVISOR FORM Owner of Property: '4e-W" ` Construction Supervisor. Name Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder. in 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, Ls -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 anyother 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 Currencurren Iiabirity Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.152 Yes No ❑ If you have checked = please indicate the type coverage by checking the appropriate box. A liability insurance policy •❑ Other type of Indemnity ❑ Bond ❑ OWNER'S INSURAN�E WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 152 of the �s. General Laws, and that my signature on this permit application waives this requirement 4 Check one: Signature of Owner or er's Agent Owner U Agent Signature: Building Official Approval: ''r O YqR� 0 TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L.. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111 S, 1 hereby certi that the debris resulting from the proposed work/demolition to be conducted at'6, Work Address Is to be disposed of at the following location: a � �7Q✓J✓����� Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. e7o' A, Signature of Application Permit No. SAd 4- - Date .4`� a - CERTIFICATE OF LIABILITY INSURANCE s�6i2ola " THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS•CERTIRCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: H the Certificate holder is an ADDITIONAL INSURED, the Policy(les) must be andonsed. If SUBROGATION IS WAIVED, subject to the terns and Conditions of the Policy, certain Policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In ROD of such endorseme s . PRODUCER Hanson Insurance Agency 632 County Road PO Box 668 Ranson MAi 02341 COMTArT Dorsain Machado, CISR PxoxE (781)293-6376 9781I293-2969 EauL Doroen8hansonins.com AFFORDING COVERAGE 111=6 nsuRERARearless Insurance INSURED Dandel Construction, Inc., DBA: The Landscape 365 Concord Street Rockland NA 02370 MURens:Safety Indemnity 3618 INSURER cAmerican Zurich Ins. Co INSURER D:Travelers INSURER COVERAGES CERTIFICATENUMRFR2014 Mastar/wc oka be RFVLgrnNMlnumao- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWRMSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIO CLAIMS Lne R TYPE OF MVRANCE MUYOER POLICVFFF EIP LM7! A 6BQ0uL LUUM= X COMMERCIAL GENERAL LIABILITY CLALMMAM ® OCCUR EULS55650842 0/20/2017 0/20/2014 EACH OCCURRENCE s 1,000,000 DAIAWE To RENTED s 300,000 n®EXP 9,r a 15,000 PERSONAL tAwNAM f 1,000,000 GENERAL AGGREGATE s 2,000 000 CM AGGREGATE Lear APPLIES PER: X POLICY PRO- �ff tot PRODUCIS-COMPATPAGG s 2,000,00 s BI AUTOMOBILE LNB0.nY ANYAUTO �OMYaED X � ID HsOb AUTOS X AUTOS 703366 0/9/2012 0/9/2014 COMBINED SINGLE LIMIT (El GOCK10,10 BOOLY IMAIRY RWPMPmI 1,000,000 s ODDLY INJURY (Per cyyq s PROPERTY DAMAGE s MadiedmPasna s 5 00 lllnmLELLA LrAs ETtCE3! U Do= C AMSLMDE EACH OCCURRENCE f AGGREGATE - s R s C WORKERS COMPENSATION AND MPIDYee' LIABILITY YIN OF�HCIMAEUGENN OCCLUDED? #MYraunde. „Y w MN) DESCRS'fIONdw OPERATIONS Wbr NIA fs08-2t00038-4-14 /27/2014 /27/2015 NC STATU- OTIV EL EACH ACCIDENT s 100 000 EL DISEASE -EA EMPLOYEE f 100,000 EL D6EIL4E•POLIC'/LMR f 500.000 D DESCMVrPDNOFOPMTXMILGMTXNGIVENKLn lm Blanket Additional Insured coverage applies respect t eGGeneralLiabili 11 only when Liability policy Y required by written contact. XCU Coverage is not specifically excluded from the general liability policy. (508)398-0836 Town of Yarmouth Building Dept 1146 Route 28 S Yarmouth, IA 02664 Machado, CISR/DCRSS 5;?� ACORD 25 (2010105) MU25 c2momwr The ACORD name and logo are registered marks of ACORD r w TOWN OF YARMOUTH d` Building Department Town Hall Yarmouth, MA 026M (508) 398.2231 ext.1261 BBUILDING PERMIT TRANSMITTAL Temp Permit No: T-14-455 Applicant Name: Thomas Irving Applicant Phone: 7818314938 Building Location: 0031 DUPONTAVE Owner's Name: TOWN OF YARMOUTH /Flax Pond Owner's Addres 1146 Route 28 South Yarmouth r MA 02664 Owner's Telephone: (508) 398-2231 (OFFICE USE ONLY Recorded By. IC Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 5/19/2014 Issue Date: Expiration Date Comments: Map/Lot: 100.1 16 x 24 concrete pad for proposed shade structure REVIEWED BY: 1. WATER DEPARTMENT: DATE: WA: 2. ENGINEERING DEPARTMENT: DATE: WA: 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: DATE: WA 5. BUILDING DEPARTMENT: DATE: WA: 6. FIRE DEPARTMENT: DATE: NIA. - COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: Date Printed: 5/22/2014 23'-3 2 SHEE1 n 2. FOOTINGS MUST BETURNED TO ALIGN WITH COLUMN AND TRUSS CENTERLINE. NOTICE An as built plan must be submitted to this department prior to foundation inspection or any further construction. TOWN OF YARMOUTH REVIEWED FOR BUILDING AND ZONING CODE COMPLI- ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE APPUCANT FROM THE RESPONSIBILITY OF'AS COMPUANC 'Z9 DATE — BUILDING OFFICIAL ,J /N /7 BFILE COPY co 0 g 0 <? o 5 0 O a o U Z 2 WORKMANSHIP SHALL CONFORM TO THE REQUIREMENTS OF THE 2. 'RICAN CONCRETE INSTITUTE, AND ALL APPLICABLE STATE AND AND REQUIREMENTS. 3. IGN IS BASED ON THE FOLLOWING PROPERTIES: 4. IGTH OF 3000 PSI. +/.17. BEAR ON COMPETENT UNDISTURBED SOIL OR 95% COMPACTED FILL C MATERIAL, UNCONTROLLED FILL, CLAY OR SILT, HIGH WATER ISSIBLE DETRIMENTAL CONDITIONS ARE FOUND, INSTALLATION OF 5, JST BE DISCONTINUED AND A SOILS ENGINEER CONTACTED. TEEL SHALL CONFORM TO THE REQUIREMENTS OF ASTM A615, SHOWN DO NOT MEET LOCAL FROST REQUIREMENTS, USE THE 6, NG OPTION ADD ADDITIONAL TIES TO MEETREQUIRED. KS AS ACING REQUIREMENTS AS VIDE LOST DEPTH REQUIREMENTS ARE NOT. MET AND NO DRILLED PIER GIVENCONTACT POLIGON ENGINEERING. IT IS THE CONTRA VERIFY THE LOCAL FROST LINE DEPTH BELOW GRADE PRIORCTOTOR'S 7• FHE ACTUAL SITE CONDITIONS MEET THE ASSUMPTIONS OVE. DRILLED PIER FOOTING OPTION -" -" I COLUMN LOCATED AT 7 FOOTING DESIGN BY POLIGON FOOTING MATERIALS BY OTHERS. b#6 VERTICAL BARS (EQUALLY SPACED) #4 TIES HORIZONTAL ® 17 O.C. w/2 TIES IN THE TOP 5" (QUANTITY OF REINFORCING -J �— 3' CLR SHOWN REQUIR-10 EMENTNGSS) MAY NOT 3" CUR REFLECT REQUIREMENTS) 7-0•' DIA. MIN. SQUARE FOOTING OPTION FOOTING DESIGN BY POLIGON COLUMN LOCATED AT FOOTING MATERIALS BY OTHERS. z CENTER OF FOUNDATIC 3" CLR S-C MIN. - NG TYP. COLUMN CING SHOWN IN GS MAY NOT REQUIREMENTS) E pp,� ED WITHIN COLUMN1, a ° C U ITHERWISE NOTED. 2 T'AS DEFINED IN ° ton 14), 13th EDITION. ANCHOR BOLT w c WEY (OR MEASURE) z 0 rINGS. AN 'HE FOOTINGS ARE 4F [ nMr.RFTF POUR. a IGON STRONGLY RECOMMENU5 u51NU ANcnun oUu .,---- • • - - 41FICANTLY IMPROVE THE ACCURACY OF ANCHOR BOLT PLACEMENT. AN ANCHOR T TEMPLATE IS PROVIDED WITH ANY PINNED BASE ANCHOR BOLT KIT PURCHASED iM POLIGON. UTSIDE CONSULTING ENGINEERS ARE DESIGNING THE FOUNDATIONS FOR THIS UCTURE, THEY MUST REFER TO POUGON CALCULATIONS FOR MINIMUM CONCRETE >PERTIES (COMPRESSIVE STRENGTH, EDGE DISTANCE, ETC.) REQUIRED FOR THE 'HOR BOLT DESIGN. CTRICALACCESS HOLE IS ALWAYS LOCATED IN THE COLUMN BASE PLATE AS SHOWN. SURE TO KEEP THE ANCHOR BOLT TEMPLATE PROPERLY ORIENTED WHEN ELECTRICAL :ESS TO THE COLUMN IS REQUIRED. TEMP ATF; MUST RF REMOVED BEFORE TAL L ING COLUMNS, 7' 01 1 /8' THRU Q. 3" ELECTRICAL ACCESS HOLE ' TYP. ARROW TIP ON TEMPLATE P. POINTS TO TRUSS SIDE OF COLUMN. 4x 0 3/4' THRU ANCHOR BOLT HOLES u 2 ANCHOR BOLT PATTERN 2 BASE PLATE THICKNESS: 1/2" ANCHOR BOLT SUBSTTRITIQN THE FOLLOWING EPDXY ANCHORS MAY BE SUBSTITUTED FOR THE CAST IN PLACE ANCHOR BOLTS ABOVE: .HILTI HIT-HY 200 ADHESIVE w/ 01 /r HAS ROD WITH A MINIMUM 6' EMEEBTTE�DMENT. -MPSON EPDXY-TIETHREAD RODS (ASTM(A307) WITH MINIMUUM/6' ALL EMBEDMENT. COLUMN 1 2" NUT TOP OF FOOTING 1 /r WASHER (4) PLACES FINISH GRADE (ASSUMED AT CONSTANT ELEVATION UNLESS OTHERWISE NOTED) 01 /nIT LONG •; r • •' '� 8' MIN. EMBEDMENT ANCHOR BOLT INTO CONCRETE FOOTING (4) PLACES • .. CONCRETE FOOTING 1 ANCHOR BOLT DETAIL g�- MEETS REQUIRED ON t C Or 28 DAY STRENGTH OF 3000 PSI. SLUMP OF 4" (+/-1"). TUF FnnTING SHALL BEAR ON COMPETENT a, THE REINFORCING STEEL SHALL CONFORM GRADE 60. " IF FnnrING DEPTHS SHOWN DO NOT MEET GIVEN, VERIFY CONDITIONS FROST LINE DEPTH DRILLED PIER FOOTING OPTION 3" CLR w /: iQI 3" CLR 3" CLR HI REF Z-V DIA. MIN. SQUARE FOOTING OPTION FOOTING DESIGN BY POLIGON FOOTING MATERIALS BY OTHERS. COLUMN LC 3" CLR CENTER OF I IV MIN. 3" 3' CLR 3'-6"MIN. FILL OF i OF ASTM A415, VENTS, USE THE D VERTICAL BARS AS IIREMENTS AS ) NO DRILLED PIER THE CONTRACTOR'S GRADE PRIOR TO AT DESIGN BY POLIGON MATERIALS BY OTHERS. BARS (EQUALLY NTAL ® 17 O.C. TOP 8. BOTTOM (QUANTITY OF REINFORCING SHOWN IN DRAWINGS MAY NOT REFLECT REQUIREMENTS) 5. NOT S m Mo Qunc/ i FOOTINGS ARE BOLT TEMPLATE IS PROVIDED WITH ANY PINNED BASE ANCHOR BOLT KIT PURCHASED FROM POLIGON. 6. IF OUTSIDE CONSULTING ENGINEERS ARE DESIGNING THE FOUNDATIONS FOR THIS STRUCTURE, THEY MUST REFER TO POUGON CALCULATIONS FOR MINIMUM CONCRETE PROPERTIES (COMPRESSIVE STRENGTH, EDGE DISTANCE, ETC.) REQUIRED FOR THE ANCHOR BOLT DESIGN. 7. ELECTRICAL ACCESS HOLE IS ALWAYS LOCATED IN THE COLUMN BASE PLATE AS SHOWN. BE SURE TO KEEP THE ANCHOR BOLT TEMPLATE PROPERLY ORIENTED WHEN ELECTRICAL ACCESS TO THE COLUMN IS REQUIRED. TFMf! nTF N ST RF REMOVED BEFORE 2 ANCHOR BOLT PATTERN 2 BASE PLATE THICKNESS:(/2" ANCHOR BOLT SUBSTITUTION THE FOLLOWING EPDXY ANCHORS MAY BE SUBSTITUTED FOR THE CAST IN PLACE ANCHOR BOLTS ABOVE: -HILTI HR-HY 200 ADHESIVE w/ 01 /r HAS ROD WITH A MINIMUM 6" EM-SIMPSON EPDXY-TIEEEB�EEDMENT. THREAD RODS (ASTM(A30) WITH MINIMUM /6-ALL EMBEDMENT. 1 /2- NUT 1/r WASHER (4) PLACES- 1 1/2' 1 12J 01/2'•XIO"LONG ��'•' ' ' ANCHOR BOLT (4) PLACES 1 ANCHOR BOLT DETAIL 1 OF FOOTWG FINISH GRADE (ASSUMED AT CONSTANT ELEVATION UNLESS OTHERWISE NOTED) 6" MIN. EMBEDMENT O CONCRETE FOOTING FOOTING "THRU CCESS HOLE TIP ON TEMPLATE TO TRUSS SIDE OF COLUMN. X03/4"THRU HOR BOLT HOLES Rw 2.1 BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR. RENOVATE • CHANGE THE USE. OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. Town of Yarmouth Building Department 1146 Route 28 • 1Slnnouth. NIA 0266-1--4-192 Tel: 508-398-2231 eat. 1261 Fax 508-398-0836 orrice Use only Permit No. /'o t6S� Planning Board Information ka.O, Type Assessors Department Infomntiore Mao L Permit Fee $ Endorsement Date Inz Deposit Rec'd. $ Date _ Recording Date Mn No. New 1.1 Property Dimensions Net Due $ Other Lot Area (sr) konuge (h) lot Coverage is Section for Office Use Onty Buildin Permit NUM I Dato Issued: Signature: Builkirij Of ate Certificate of Occupancy is Is not required Section 1 - Site Information 1.1 property Addresss 1.2 Zon' Information oning District Proposed Use 1.3 Building Setbacks (it) Front Yard Side Yards Rear Yard Required I Provided Required I Provided I Recruited I Provided I Water Supply (e1.O.L. a. AO. S 541 I1.5 Flood Zonis Public Private Zone: _ Section 2 - Property Ownership/Authorized Agenl 2.1 Owner of Record: ---owW -,-rF yAai,%7.?Jt4 Name (print) xt Convnentx BFE: Mailing Address: 508— 223/ RECEI Name (print)MP MaeirrgAddress: BUILDING DEPARTMENT Signature Telephone er- -- Section 3 - Construction Services 3.1 L ensed Construction Supervisor. Not Applicable (d�- a) 14C'J tic 0-:501 a License Number ` Address /— — Expiration Date Signature Telephone f of 4 OVER Company Name Address Signature Contractor. Telephone Not Appkable V Registration NumOef Eaclraft Este Jef:[IVp 9-�fVlnCIi WII ,Ii6ulAupY,a,YV r,u,vo-w1'^•�-•-"�' ����.�. 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 - Professional Design and Constriction Services - for Buildings and Structures Subiect to Constriction Control Pursuant to 780 CMR 116 (containing more than 35,000 C.f. of enclosed space) Section 5.1 Registered Architect Nat Applode Name Ineyrstrant„ rlegtstratlon Number Address Eaptratlon Dab _ ciffnaft a Telephone Company Name Person Responsible for Construction Signature Not Applicable ❑ 2 oft " Section 6 - Description of Proposed Work (check all applIcable) New Construction ❑ (tor maniple family Dory) No, 01 Bedrooms (for multiple family only) No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ I Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Descn . ptlon_qJ Prop sed Work: Section 7 - Use Group and Construction Type Building Use Group (Check as appliicapable) Construction Type A ASSEMBLY ❑ A-t ❑ A-4 ❑ A-2 ❑ A-5 ❑ A•3 ❑ 1A ❑ 1B ❑ B BUSINESS ❑ 2A ❑ 213 ❑ 2C ❑ E EDUCATIONAL ❑ F FACTORY ❑ F-1 ❑ F-2 ❑ H HIGH HAZARD ❑ 3A ❑ 313 ❑ I INSTITUTIONAL ❑ 41 ❑ 1.2 ❑ 1.3 ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R-1 ❑ R_2 ❑ R-3 ❑ SA ❑ 58 ❑ S STORAGE ❑ S-1 ❑ S-2 ❑ U UTILITY ❑ SPECIFY. M ul"ED USE ❑ SPECIFY: IS SPECIAL USE ❑ SPECIFY Complete this section 0 existing building undergoing renovations, additions and/or change In use. Existing Use Group: Existing Hazard Index 780 CMR 34 Proposed Use Group: " Proposed Hazard Index 780 CMR 34 Section 8 Buildina Helaht and Area Number of noors or stories include basement levels Floor Area per Floor (sn Total Area All Floors (sf) Total Height (ft) Section 9 - STRUCTURAL PEER REVIEW (780CMR 110117) Independent Stnxtural Engineering Structural Peer Review Required Yes ........ No ... SECTION 1 Ca OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1. , as Owner of the subject property, hereby authori A6 to act on my beh matters relative to work authorized by this building permit application. e/ Sig re of Owner �- I Date 3 014 OVER I, , as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name / of Owner/Agent III - F.4TIM0' COSTS Item I (DoNam) to be completed try per it applicant 1. euik&g ^^ J12 2. Electrical 7. Plumbing I Gas 4. Mechanical (HVACI S. Fire Protection & Total . (1 . 2 . 7 . 4. S) T. Total Square Ft la a arena a W6m.1 Check Below ❑ Conservation -Commission Fling (it appricable) ❑ Old Kngs Highway 6 Historical Commission approval (if applicable) Date 4 of The Commonwealth ofMassaehusettt Department oflnduaWdAccidents Office oflnvestigadons 600 Washington Street Boston, MA 02111 'Vt&lV www.massgoM is Workers' Compensation Insurance Affidavit: Bul7ders/Contractors/ElectrIcians/Plnmbers Aaolicant Information Please Print Legibly Address: U /StatdZi : Phone #. Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with ' 4. ❑ I am a general contractor and I employees (full and/or part-timesub-contractors have hired the sub-contracto6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling ship and have no employees Tie sub -contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance required:1 5. ❑ We are a corporation and its 10.0 Medical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' compright of exemption per MGL 12 ❑ Roof repairs insurance ] t c. 152, § 1(4)� and we have no 3a. ❑ I am a homeowner acting as a employees. [No workers' 13.❑ Other general contractor (refer to #4) comp. insurance required.] 'Amy apptieaot &d cheek -box #1 anon also till our the serdm below snowing thecwohaa' ar�a�lMHq mfmmadoe. t Homeawotxs wbo sob®t thin affidavit iadadog bey ere doing as work end then hire onside counctom sobs it a new affidavit hnifiudng such. rCoeeaeto s dun ehwk this box cart attached an addidosal sheet showmg the exam of the sobeoamaon sad stare whether or ant d,me eaddes beve employees. If the sub-mnvaam haw agloyee& they mast provide drew wmdcars' comp, policy obey lam as employer that is provblbrg worsen' compensation bssarcneefor my employees Bdow Is thepo&7 and job site brformadom Insurance Company Ile Policy # or self -ins. Lie. M is yA U O<W aq — 4t— N Expiration Data Job Site Address ,( City/Stamop: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Fail= to a== coverage as required under Section 25A of MGL c.152 can Lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year impfisonment, 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 cerf�iJj� under the pa and peraltles ojperjw y that the btjormadon prodded above'frue and correei Si®attire: [1/r _ Date• �� �/ / Y' Phone #: OfJfclal are only. Do not write In dds area, to be completed by city or town oB LIal City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Permlt/I.icense # 3. Cityfrown Clerk 4. Electrical Inspector S. Plumbing Inspector Contact Person: phone #- AW Information and Instructions Musachusemr deaeral Laws chapter 152 requires all empkytrs to provide workers' compensation for their empkyccL ptasuaat to this statute, an enptgn is defined u'_every person m the service of amd= under any catrad of hire, express or implied. oral or written.' An upkyr is defined u "era individual, partae:ship, ass9d"1or4 corporation oc other Leal entity. or my two or more of the faretoiag enpged is a joint F n"I au, mad ir1011i" for L'Sd rcFU=W iva cf a dwased empbM a the receiver or, , - - of as mdMdo4 partnership. ssaociatios a other kW enf@y, employius cmpbyecL However the owner of a dwelling home having not more thin 6M apatmeats and who resides thereisi a tbs of the dwelling hooas of another who employs persons to do memtensuce, canal -,era a repair wort an such dwelling house or on the hounder or building tppartemnt thereto shall not because of loch eapbyoeut ba deemed lobe an employer• MGL chapiw 1S2,125C(6)elm SWN that "eery at b w bW tkandat agmcy slag wltftbw the 'nano er renewal of a Beene tw prrmlt to operate a b+dtaese or to eeastrad bs MbW lathe dsetaosweatth fer aq appBesat whe has net produced acceptable eddeaea of teenpBtaa with the Inswun ee I - regaire V Additionally. MOL ehapees Ut 125M statea `Ncidw the commonwealth nor say of its political mbdkvidane shag eats into nay coated fm the periccmana of pubfie wodt until acceptable evideaee of eompiimn with the knstaaace segmremeats of We chapter have bees presented to the eoohaeting aahority.' AppBesaat please fill one the wori9era• eoapeusatiaa atIIdnit eompfetsly. by checking the basrs that apply to you sieaatim nod• if neasssy, supply nob-eolstroct«(s) minds), addtsaa(a) and plane aamber(s) aloes wish their certificate(s) of insmsm= I km tad Liability Cmpmie (LLQ a limited Liability Partnerships (Lim with no employe" otba thin the members art arm not ngahed to carry work e ' eompensatim kooumana. Ito LL.0 or LIP doe have cmpkoyeea, a policy is regained Be advised that dde affidavit my be subrmmed to the Deparhment of Itsdustial Accidents arr eao6rusada n of ioaaanee coverage. Ake be two to sip mad date the affidavit. Tl r affidavit should be attsne I to the city or tows that the applkadoe for the pemat or lkcew in b ft requeaed, we the Department of Lxha zid Accidents. Should you ham any gresdow regamUns the law ar if you ae tegatred to obtaa ■ wo bcW can pensados polka. pkw cad the Department at the number listed below. SdP insured eompmie should eater their Self-,mamfe. licanae number as the ap4eapciaas Use. City err Taws Ofelals plow be use that the affidavit is complete and printed kp'bly. The Department has provided a space at the boaos of the affidavit far yom to fill out is the neat the Office of InvesdPdavas has to eoctaet you repadfog the appUeaat Pkse be a" to fig in the peruMlecu a maaI which will be used an a refetenoe mbar In additbq as applicant that ®st submit asaftiple pesm&B=n a VPlkadow in my &CM, yes, erred only submit oar atEdavit mdkatmg enmnt polkry iatatatSos (if aeeeaary) and tinnier "Job S[4 Addesaa" the applikant should write 'all badow In _(city or towaV A copy of the affidavit that he bees officially stamped or madzd by the city at town ray be provided to the applkaot r proof that a vdkd afidavit is on Me fix Mae pa:ffita or Ikemea A new atikdtrit aont be filled out each year. Wbere a home owner at citba to obtaining a liceae at permit out relmsed to my badness or con>merekal venture (Le. a dot Beene or permit tobran teaves ere.) said persm is NOT tegoited tocompletethia affidavit The OkEce of Investiptbns would lilaf to than} you is advance for yaw cooperstis and should you have my querulous, pieax do not hedtafe to give us a ail fix Depatmin t'a addren telephmw and fu muster The Commonwealth of MLwwJn xtfY Department of Iadttstrial Atxidenb ofl" of Ifftr"dPdaas 600 Washington Strt d Bastott, MA 021 it Tel. A 617-727-4900 a xt 406 or 1-977-MASSAFE Revised 11-22-06 Fax 0 617-727-7749 www.mass.gov/dies TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRIM} r f! Job Location: Number Owner of Property. Construction Supervisor. Address: Z2 licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder. Street u/ l License Village License No. 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 UZ No ❑ If you have checked = please indicate the type coverage by checking the appropriate box A liability Insurance policy .[A Other type of indemnity ❑ Bond ❑ OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 2 of the M General Laws, and that my signature on this permit application waives this requirement Q Z Check one: signAre of owner or oAAes Agent Owner ❑ Agent Signature: Building Official Approval: TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1115, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at-3 / 6,ox;7-" Work Address Is to be disposed of at the following location: S' i - /&..t vx- ��l�Y1lf� Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Application Permit No. Date ___01 CERTIFICATE OF LIABILITY INSURANCE DA,z 2014"Y"' 5/6/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED .REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: a the CertMCM holder Is an ADDITIONAL INSURED, the PONCY(Iss) must be endorsed. V SUBROGATION IS WAIVED, subject to the terms and conddions of the policy, certain Policies may require an endorsement A statement on this cerOBcate does not confer rights to the certlRcate holder In Neu of such endorseme s . PRODUCER Hanson Insurance Agency 632 County Road PO Box 668 Hanson NA 02341 WACT Doreen Machado, CISR PHOME (781)293-6376 Nt t7311293-2969 NIAL .DoresnEhansonins. cow AFFORDING COVERAGE NAIOI sSUfU!RA: NM&rlesa Insurance NSURED Dandel Construction, Inc., DBA: The Landscape 365 Concord Street Rockland HA 02370 INSUMF, wrjuRme:Safety Indemnity 3618 NsuaERcAmerican Zurich Ins. Cc RSRERD:Travelers sysurmM COVERAGES CERTIFICATE NUMBER:2014 Master/rc pkg be REVISION NUMBER: I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR WAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L R TYPE OF INSURANCE SUM /NUMBER POLICY ESP LEM GENERAL LIABILITY EACH OCCURRENCE s 1,000,660 DAMAGE TO RENTED 6 300,00 A X COMMERCIAL GENERAL LIABILITY CIAM"ADE ® OCCUR BMS5650942 0/20/2013 - 0/20/2014 MED EXP " 6 15,000 PERSONAL A ADV NA1Rr 6 1,0o0,000 GENERAL AGGREGATE 4 2,000,0001 GENL AGGREGATE _0 LIMIT APPLIES PER: PRODUCTS-COMPIov AGO s 2,000,000 POLICY f I PRO- Loc s AUTOMOBLE LIABILITY COMBINEDIEII a 1,000.00 BODLYMARYO'wImu m) 6 BIANY AUTO �� ED ]( �1EDlAID 703366 O/e/2017 O/9/2014 BODLY KAM Oy.INN4ay 6 snqcL HIRED AUTOS X �ON014OSwm Mm s 5.00 UMBRELLALIM OCCUR EACH OCCURRENCE Is AGGREGATE $ ESCEU LUX CIAMSMADE RETENTION s C WORKERS COMPENSATION WA: STATLL OT1V AND EMPLOYERS LIAlLITY YIN OF�FICEANEMBENERCLIAR0E IMr��AIIn Iwl MIA LZOB-2a0003B-4-14 /27/2014 /27/201! EL EACH ACCIDENT s 100000 EL DISEASE -FA flpL s 100,000 DESCRIPTION OPERATIONS below EL DISEASE -POLICY LMrr s ' 500.00 D DESCRIPTION OF OPERATION! I LOCATIONS IVEIIIREO LANcb ACORD 10%IWdllenTlF sdwOi. M wA SPSA r mPied!) Blanket Additional Insured coverage applies with respect to the General Liability policy only when required by written contract. 3= coverage is not specifically excluded from the geaaral liability policy. (508)398-0836 Town of Yarmouth Building Dept 1146 Route 28 S Yarmouth, M 02664 SHOULM ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE POLICY PROVISION& 0ISM2010 ACORD CORPORATION. Ali rights reserved. INS025 tlmmstsl The ACORD name and logo are registered marks of ACORD a TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (506) 399-2231 ext.1261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-14-456 Applicant Name: Thomas Irving Applicant Phone: 7818314938 Building Location: 0031 DUPONT AVE Owner's Name: TOWN OF YARMOUTH/ Flax Pond Owner's Addres 1146 Route 28 South Yarmouth MA 02664 Owner's Telephone: (508) 398-2231 REVIEWED BY: (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 5/192014 Issue Date: Expiration Date Comments: Map/Lot: 100.1 construct 16 x 24 slab 1. WATER DEPARTMENT: DATE: WA: 2. ENGINEERING DEPARTMENT: DATE: WA: 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: DATE: WA: 5. BUILDING DEPARTMENT: DATE: WA: 6. FIRE DEPARTMENT: DATE: WA: PLEASE NOTE COMMENTS: RECEIPT OF COPY. SIGNATURE OF APPLICANT: DATE: Date Printed: 5222014 TO`,kjN OF YARMOUTH WATER DEPARTMENT S? Ruck Wand F.c2d 6"•'=;t 5'ar,ncv:6, P4:4 02c-3 i71-7911 ' F2X' 1_0F; 17'7.1-77iC BUILDING PERMIT APPLICATION r,r:;2AQVMCM4R1 CTr-MI`Ct!-rPA61CKAZ1-PAL `:ET dg. Site Lecatlon �fig)Ol/ / i4 Map #: Lot Proposed Improvement: _ G��t/G/ ?�= -?p- 41 oEo� 10,f116411116 Applicant: r� Address /4/a pi *7- Tel. #; 33 , 7 jute 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 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, ASafety, Property Protection;,-i.e. Smoke Detectors, Sprinkler Systems, Etc... Signature of applicant / U to PLEASE NOTE: COMMENTS: ANCHOR BOLT NOTES PINNED BASE STRUCTURES (ANCHOR IS TS I OCATED WITHIN COLUMN): uy\\` CONFORM TO THE REQUIREMENTS OF THE 1. ANCHOR BOLTS SHAL BE TM A307 (GRADE A) MATERIAL NLOE OlHERWI E NO i ED a e L JVORKMANSHIP SHALL 2. ANCHOR BOLTS SHALL BE EITHER "HEADED" OR "THREADED WITH NUT" AS DEFINED IN o, rnI'Ii RICAN CONCRETE INSTITUTE, AND ALL APPLICABLE STATE AND THE AMERICAN INSTITUTE OF STEEL CONSTRUCTION MANUAL (PART 14), 13th EDITION. o 0 RE THE ANCHOR BOLT W AND REQUIREMENTS. 3. HOOKED ANCHOR BOLTS ARE NOT ACCEPTABLE. �^o [a~ ` GN IS BASED ON THE FOLLOWING PROPERTIES: 4. ACCURATE ANCHOR BOLT PLACEMENT IS CRITICAL. TO ENSU GTH OF 3000 PSI. LAYOUT MEETS THE DIMENSIONS REQUIRED ON THE DRAWINGS, SURVEY (OR MEASURE) y-i•), THE LOCATION OF ALL ANCHOR BOLTS PRIOR TO POURING THE FOOTINGS. AN BEAR ON COMPETENT UNDISTURBED SOIL OR 95% COMPACTED FILL ADDITIONAL SURVEY (OR MEASUREMENT) SHOULD BE MADE AFTER THE FOOTINGS ARE MATERIAL, UNCONTROLLED FILL, CLAY OR SILT, HIGH WATER POURED TO CONFIRM THE ANCHOR BOLTS DID NOT SHIFT DURING THE CONCRETE POUR. a SSIBLE DETRIMENTAL CONDITIONS ARE FOUND, INSTALLATION OF 5POLIGON STRONGLY RECOMMENDS USING ANCHOR BOLT TEMPLATES BECAUSE THEY . O 1ST BE DISCONTINUED AND A SOILS ENGINEER CONTACTED. SIGNIFICANTLY IMPROVE THE ACCURACY OF ANCHOR BOLT PLACEMENT. AN ANCHOR TEEL SHALL CONFORM TO THE REQUIREMENTS OF ASTM A615, BOLT TEMPLATE IS PROVIDED WITH ANY PINNED BASE ANCHOR BOLT KIT PURCHASED B SHOWN DO NOT MEET LOCAL FROST REQUIREMENTS, USE THE FROM N. 6. NG OPTION AND EXTEND AS REQUIRED. EXTEND VERTICAL BARS AS 1F OUTSSIDEIDE CONSULTING ENGINEERS ARE DESIGNING THE FOUNDATIONS FOR THIS v STRUCTURE, THEY MUST REFER POLIGON CALCULATIONS FOR MINIMUM CONCRETE AIDE ADDITIONAL TIES TO MEET SPACING REQUIREMENTS AS .. 'OST DEPTH REQUIREMENTS ARE NOT. MET AND NO DRILLED PIER PROPERTIES (COMPRESSIVE STRENGTH. EDGE DISTANCE, ETC.) REQUIRED FOR THE 0 0 ANCHOR BOLT DESIGN. GIVEN, CONTACT POLIGON ENGINEERING. IT IS THE CONTRACTOR'S 7ELECTRICAL ACCESS HOLE IS ALWAYS LOCATED IN THE COLUMN BASE PLATE AS SHOWN. � VERIFY THE LOCAL FROST LINE DEPTH BELOW GRADE PRIOR TO BE SURE TO KEEP THE ANCHOR BOLT TEMPLATE PROPERLY ORIENTED WHEN ELECTRICAL: Q • ArrFSS TO THE COLUMN IS REQUIRED. TEMPLATE MUST BE REMOVED BEFORE THE ACTUAL SITE CONDITIONS MEET THE ASSUMPTIONS 7' (ZS 1 1 /8" THRU LOVE. Q. 3• ELECTRICAL ACCESS HOLE TYP. 1 1/ ARROW TIP ON TEMPLATE DRILLED PIER FOOTING OPTION P. POINTS TO TRUSS SIDE OF COLUMN. 4X 03/4' THRU 3"CLR -1 1 COLUMN LOCATED AT - ANCHOR BOLT HOLES r FOOTING DESIGN BY POLIGON FOOTING MATERIALS BY OTHERS. BARS (EQUALLY WTAL 012' O.C. I 3" CLR IA CLR 7-0" DIA. MIN. SQUARE FOOTING OPTION FOOTING DESIGN BY POLIGON FOOTING MATERIALS BY OTHERS.- —LOCATED AT cFMER OF FOUNDATION NOT TOWN OF YARMOUTH "' U REVIEWED FOR BUILDING AND ZONING CODE COMPLII.AN E ERRORS OR OMMISSIONS DO NOT RELIEVE THE O APPLICANT FROMTHERESPONSIBILITY OF "AS COMPIIANj���E�' DATE z - IldO� BUILDING OFFICIAL L PCA'- 'OJ✓ �p��%/ � �-�� 2 ANCHOR BOLT PATTERN I rp n O� �I `�/ o✓I C✓L 2 BASE PLATETHICKNESS: L_ PY ANCHOR BOLT SUBSTRUTION THE FOLLOWING EPDXY ANCHORS MAY BE SUBSTITUTED FOR THE CAST IN PUCE ANCHOR BOLTS ABOVE: -HILT( HTT-HY 200 ADHESIVE w/ 01 /2' HAS ROD WITH A MINIMUM 6" EMBEDMENT. -SIMPSON EPDXY -TIE (SgE'f) ADHESIVE w/ 01/2"ALL- THREAD RODS (ASTM A307) WITH MINIMUM 6' EMBEDMENT. FOOTING TYP. EACH COLUMN 345 HORIZONTAL BARS (EQUALLY SPACED) .0• I EACH WAY, TOP S BOTTOM (QUANTITY OF 01/7x10" LONG REINFORCING SHOWN IN ANCHOR BOLT 3"CUR DRAWINGS MAY NOT (d) PLACES REFLECT REQUIREMENTS) N-6" MIN. NOTICE An as built plan must be submitted to this department prior to foundation inspection or any further construction. NUT TOP OF FOOTING WASHER 'LACES FINISH GRADE (ASSUMED AT CONSTANT ELEVATION UNLESS OTHERWISE NOTED) r .•'. 8" MIN. EMBEDMENT INTO CONCRETE FOOTING CONCRETE FOOTING 1 ANCHOR BOLT DETAIL 1 M �7 2. FOOTINGS MUST BE TURNED TO ALIGN WITH COLUMN AND TRUSS CENTERLINE. \ \ 23-3718"REF. I I 90.000 _ \ - TYP. \� I I � 45.00° � / TYP. � \\ \-- - - - _ _ _ - Apr 1514'07:50a DANDEL CONSTRUCTION INC 3392444219 p.2 \ i IN Official sepnly 0 Permit NO. _IQ e�a>frneel of ,y:n �Jsrvice! BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked aerve blest) APPLICATION FOR*PERMIT TO PERFORM ELECTRICAL WORK AII wort to be pmf==d in acxordance w•itb the Mzssaehvsem Elecaieal Cock (MEN. MIR 1200 Im (PLUSEPRWTIMAWORMEdLLINFORbLITTONJ Date: W • City or Town of YA_RMOUTH To the IrLrpedor of Wires: N W By this application die V"`=7igned fives nonce of his or berintention to pe{.vim the electrical wad; described below. i o Location (Street d Number) / r- tvl O "i z OwaerorTenaat Telephone No. V _J Owner's Address CLJ I Q m Is this permit in ronjuaa)on with a building permit? �Ycs�ONU�Appropriate Box) Purpose of Baild'm" m Utility Authorization No. Existing Service pm P \t�QaL 12- aa+a �w 3 Ps 'volts New Sersitt Aarps / Vols Number of Feeders and Ampacity Location and Nature of Proposed Electrical WorL- Overhead ❑ Undue d ❑ No. of Metes Overhead ❑ Undgrd ❑ No. of Meters Plo. of Recessed Luminair-es wmmctrnr of ue oaaw.in� No. of CcL-Svsp. (Paddl Fans Lzb/e be w.otwed the Ir ro(A'oer. No. of ota! No. of Lumivatre Outlets No. of Hot Tnbs Transformers ICVA Generators ICVA No. of Luminaires Swlinming Pool A over a_ ❑ ❑ o. o mergeney oag crud. crud. BaCenIInitr No. of Receptacle ODI No. of Orl Emaers ' ALAR1iS No. of Zones No. of Switches No. of Gas Burners ' ' o. o etection an No. of Itznga • _ No. of Air Cond. Initfatfns Devices - Z.o� No. ofAlerting Devices No. of Waste Disposers Pat camp amber one Totals: o. o ontatne No. of Dishwashers - Space/Area Heating ICW' Detmflou/Alertin"Devices omup Lod ❑ Connectlan ❑ Other No. of Dryers Heating Appliances KW ecnrity yyssttee��;; o. o ester No. of Devices or . alent KW Heaters I o. o a v Datavo asts Sims BallNo Sievices or E vivalent D No. Hydromanage Bathtubs No. of Motors Totes! H? ecommamcanons icing No. of Devices or ivaleat OTHER: 1N57AL{,91—W of ¢per �. 'i-� u f" 6 /fze55 �• Frr+rat.A Valve of ElxDical Wori` �` f' Aaach odd'fioia1 derat/ tfdesbed or ar required die /nspector of ira�ar. work to St=� K(C° 6y municipal policy.)Icspecdons to be regnener, sed in accordance with MEC Rule 10. and upon completion. INSURANCE COVERAGE: Unless waived by the owno permit for the performance of electrical work may issueinheres the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies duct such coverage is in force, zod has exhibited proof of same to the permit issuing otnee. CHECK ONE: 1NSURANCEDr BOND ❑ OTHER ❑ (Specify) .S-4r_4 S. I cord& andcr the pairs and perm&ies of perjury, that the friformadon on this app rt IT bue and eo fete. IR FM NAME: J� , "`p e r Eit'cfri c. Co 1L[t_NOs 4/7/2q Licensee: _TL,.,.._. f (47 4:p1e11x61a, carter 1 Address_ 7-7 .} J *Per bLG.L. c. 1 OWNER'S INS required by law. Owneturer/Agent Signa _ LIC- NO_ SUL Tel. No_ >8t-7o6-v3 t� 17, s. 57.61, s wort re Alt Tel. No_��— ecvrity quires Department of Public Safery'•S" License•, Lic No. JRANCE WAIVER: I am aware that the Licensee doer not have the Iabiliry insurance coverage normally BY my sigaaaaave below, I hereby waive this requirement I am the (check: one) owner owners Y "IL Telepbone No. PERMIT FEE: S Signatare aft w d JF'-;AM,'b 4 Yr J K-t. At Sit, ij rof Ol ew N�q A, 1 46 mm 'e 3� U p0 NT Aviv POND - RECEIVED — minor ,s• . �.• APR 01014 _ ::. - - BUILDING DEPARTMENT - - - - - - - er; y 521 CMR: ARCIIITECIURAL ACCESS BOARD 521 CMR 33.00: DRESSING, RTMO AND CHANGING ROOMS C33.1 DRESSING, mTING AND CHANGING ROOMS Where provided, dressing, fitting and changing rooms shall comply with the following. 33.2 DISTRIBUTION. 5%, but never less than one, in each cluster of dressing, fitting and changing rooms shall be accessible. Where separate sex dressing, fitting or changing rooms am provided, at leas[ one such room for each sex shall be provided: 333' LOCATION Accessible dressing, fitting and changing rooms shall be on an accessible route complying with 521 CMR 20.00: ACCESSIBLE ROUTE A wheelchair taming space complying with 521 CMR 63, Wheelchair Turning Spam shall be provided In every accessible dressing. fitting and changing room entered through a swinging door. sliding door or certain. 33A SIZE The accessible dressing, fitting or changing room should be a minimnm of five fed by six feet (5'-0" by 6'-0" = 1524mm by 1829mm). A clear floor area of 60 inches in diameter (60" = 1524mm), measurer at 12 inches (12" = 305mm) above the floor, shall be provided in every accesn'ble dressing. fitting or changing room. See Fig. 33a. 1529 a4• aio V 0 . - . Aeeaaalble changing Roam Figure aaa 33.4.1 No door shall swing Into any part of the taming space. 33.42 • A coat hook shall be provided within the dressing, fitting or changing room and located no higher than 54 inches (54" =1372mm) above the floor. 333 DOORS . Ali doors to accessible dressin& fitting and changing rooms shall be in compliance with 521 CMR 26.00: DOORS AND DOORWAYS. 33.6 SEAT . Everyaccessr7ik dressing, fitting and changing room shall have a seatlbench that complies with c_ the following. ` 33.6.1 The scat/bench shall be 241nches by 48 inches (24" x 48" = 610mm by 1219mm) and fixed to the wall along the shorter dimension. 521 CMR -141 ' 521 CMR ARCSTTECPURAL ACCESS BOARD 33.O0-. continued 33.6-2 The seat shall be mounted 17 inches to 19 inches (17" to 19". - 432mm to 483mm) above the finish floor and open below with a minimum of 12 inrbes (12" = 305mm) In height measured from the floor. See F1g. 33b. .... irror7- - ,--M. min146a7■=1= T n ... " Changing ttooma - - Flpura asb - 33.6-3 CZearflooripace sludl be provided alongside the bench to allow a person using a wheelchair to make a parallel transfer onto the seat :. 33.6.4 Tbeseat and attae_t tmen••shaUcomplywiththerequirementsforstrucowdinrngthin521CMR 5.00: DEFDMONS. 33.7 MIRROR Wbere minors are provided in changing rooms a full-Iwgtb miam measuring at least 18 inches wide by 54 inches high (18' by 54" = 457mm by 1372mm), shall be mounted 18 inches (18' - 457mm) above the finish floor, in a position affording a view to a person on the bench as well as to a person in a standing'position. See Fig. 33b. • 127/06 521 CMR - 142: RECE EVE D MAY 08 2 4 BUILDING D sr�_ ENT i EXPRESS BUILDING TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: l �XY�XYal7 �3 h 13�) i � I:�j 1�ali i Map: Parcel: • u• CONTRACTOR W I Office U y PermitaT- Amount Permit expires 180 days from issue date .TION XIS Residential W Commercial V Fat Cost of Construction S Z S O'B _l 2 Home Improvement Contractor Uc. # Constructlon Supervisor Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: Worke'a Comp. Policy# WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: # of Squares Replacement windows: # Replacement doors: # Roofing: # of Squares ( ) Remove existing* (max. 2 layers) Insulation��,(�/fyy�� Old Kings Highway/Historic Dist. (.) Replacing like for like ^ _e `) d w r6f-f�474 Me debris will be disposed of at [oration of Facility I declare under penalties of perjury that the natemenu herein contained ate one and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just case for denial or revocation of my license and for prosecution ®der MG.L. Ch. 268, Section 1. Applicant's Signature Owners Sigmtore (or Approved By Bulldog Official (of designee) L Zoning District: Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District Within 100 R of Wetlands: Yes No Yes No The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 -Ia'' •www,mass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectricIans/Plumbers Apolicant Information Please Print Legibly Name (Business/Organindonandividud): Address: iararei[a : Phone #. Are you an employer? Cheek the appropriate box: I. ❑ I am a employer with 4. I am a ❑ general contractor and I Type of project (required): employees (Call and/or part-time).' have hired the sub contcacton 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- . listed on the attached sheet 7. ❑ Remodeling ship and have no employees These subcontractors have g, Demolition working forme in any capacity. [No workers' insurance employees and have workers' comp. insurance.: 9. ❑ Building addition comp. required] 5. ❑ We are a corporation and its 10. ❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their . 1 L❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0Roof repair insurance required] t 3a. ❑ I am a homeowner acting as a C. 152, 11(4), and we have no employees. [No workers' ME] Other general contractor (refer to #4) comp, insurance reGuired.l 'Any applicant that checks box #1 most also bit am the section below showing their wad=, wo�adod�oiicy mfoomnoa. t Homeowners who submit this affidavit Indicating they an doing sit wok and then him outride cwaactos toast submit a new affidavit indieating such. tConttactan that ehedt this box most attached an additional sheet showing the name of the sob•eoon>,cton and sum whether or na those emitkes bave employees. If the sub -contractors have employees, they Est provide their workers' comp• polity rumba. I am an employer that Is providing workers' compensation IMBrance for wry employees. Below It the policy and fob site informadom Insurance Company Name: Policy # or Self-hm Lic. Expiration Date Job Site Address: City/StatCMp: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Fail' ; 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 SI j00.00 and/or one-year imprisonment as well as civil penalties is the form of a STOP WORK ORDER and a fine of tip 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. 'do hereby cer * under the paint and penalties of perjury that the information provided above it true and correct Sigpatme: Date Offld 1 use only. Do not write In this area, to Be completed by city or town official City or Town: Permit/I.tcense # Issntng Authority (circle one): 1. Board of Health 2. Building Department 3. Cltyfrown Cleric 6.Other 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires aR employes to provide workers' compensation foe their employees. - Pursuant to this statiute, an empkIn is defined as "_every person in the service of another under any contact of hits, express or implied, oral or written" An emplga is defined as "an individual, psamership, association, corporation or other legal entity. or say two of more of the foregoing engaged in a joint enterprise, and inchrding the lepl represenwives of a deceased employer, at the rtYeiva or trustee of ea individual. pamaship, association or other legs) entity, employing employees. However the owner of a dwelling home baying not more than thme apartments and who resides thereink a the occupant of the dwCMMg house of another who employs persons to do rujinteuloce,cousmrctiou a repair work on such dwelling boost cr an the gromtda or buMing appurtenant dratm shall Got beams of sneh employment be deemed to bean employes" MGL chapter 152,125(:(6) also states tW "eery state sr keg lkendag ag"Ky shall withboll the balm err renewal of a lfeensa ur permit is operate a business W to constrnet buildings 4 the eomnso swealth for a" applkaat wbo has not perodoed aectP ,@ tvldeeea Of compltana with the lusaaaee coverage regdrei. Additionally. MGL chapter 152,12XM states "Neither the commonwealth nor any of its political subdiv'rsiom shall Of tic wort until acceptable evident of compliance with the insurance eater into any contract for @r p been pre to the ." cequtuemeata of this chapter have been presented Applleaata Please fill out the workers' conVeasadon affidavit completely, by checking the bases that apply to your situation sad, if accmaery. supply ems) name(s), sddten(es) and Phoat maaba(s) along wiwith th Go employeesother thin theianasaee. Boated Usblity Companies (LLC) a ti�6ip ted Liability Pamas(LLP) maaa or P+tmem an not requked to carry workers' eoapmsadm losmance. If an LLC or LLP does have employees, a Policy is requir Be advised tbd d& affidavit may be submitted to the Department of Industrial Aebstiand date the aMILTIL The afidavit sboold Accidents for conformation of insurance coverage- p be retuned b the city Of town tbd the apptieatlaa for the permit of license Is being regaespcd, net the Department of Industrial Aeddmta Should you have any questions regarding the law cc if you as regdmd to obtain a wakosa' compensation policy. ples" can the Department d the mnobef listed below. Self-ianaed companies should eater their City or Taws 0111daia Please be eras that the affidarit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill tot in the event the OtiSce of Iarestiptions has to contact you regarding the sPPlia"t Please be ass to fill fa the parnitliieeass aomlxr which wUl bo used u a referents aarmber In addition, as rppifeant that mad submo t multiple perm Wlie eow appliadanf in any Qom year. need only submit ono affidavit Wiathig cmreat polky iafotm<tloa (if ueessary) and under "Job Sits Address" the applicant should write "all locatlooa In (City of own)." A copy of the affidavit that has berm officially skimped or matked by the cityor town maybe provided lathe applicant as proof that a valid affidavit is on file for 0>1 permits or lieeo sm A new affidavit mat he filled out each yen. Where a hone owner or citizen is obtaining a license at permit not related to any business of commercial veahaa (Le. a dog lieeme of pernit to bnn team ere.) said person Is NOT tequired to couplets this affidavit The Office of lovadptiont would l7ro to thank you in advance far your cooperation and should you have my goesdans, please do not hesitate to Si" us a all lice Department's address telephone and fax member The Commonwealth of Mamachusetts Department of Industrial Accidents Other of Investhptlons 600 Washington Street Boston, MA 02111 Tel. S 617-727-4900 ext 406 or 1-877-MASSAFE Fax M 617-727-7749 Revised 11-22-06 wymmass.gov/die Williams Scotsman, Inc. 79 River Road Uxbridge, MA 01569-2246 An ALGECO SCOTSMAN Comp" Your Williams Scotsman Representative Deborah Makowsky Phone: (603)324-1813 Eat. 76013 Fax:(508) 278.2354 Toll Free: 800-732-1500 Contract Number.436974 Revision: 3 Date: April 25. 2014 Lease Agreement Lessee: Contact Ship To Address: Taws of YarnwxM Parks and Recreat Mona Solmonte 424 Route 28 424 Route 28 SOUTH YARMOUTH. MA, 02664 W. Yarnouth, Massechusetis, 02673 W. Yarmouth, MA, 02673 Phone: 508-398-Mil x1525 Farr: Email: msdmonte@yamw Ah.ma.us Delivery Date(on or about): GIIW2014 Roe I Prid" Per Month Quantity Price Extended 24x8 Mobile Was (20x8 Box) Unit Number: 1 $200.00 $200.00 Steps- OSHA Aluminum Rental 1 535.00 535.00 Minimum t.esse Term: 3 Months Total Monthly Building Charges: $200.00 Other Monthly Charges: W.00 Total Rental Charges Per Month: 5235.00 Do" t Installation Bock and Level 1 $65.00 $85.00 Delivery Freight 1 $224.40 $n4.40 Teardown 1 535.00 $35.00 Return Freight 1 5224.40 $224.40 Due On Final Imrdce•: $259.40 Total Charges Inckiding 13) Month Rental, Delivery, Installation i Return— 31=80 Summary of Charges Model: M0248 OUAwrm 2 dal Charges for (2) Building(s): $2,507.60 RIto G^00,v P TYPE OR PRINT CLEARLY MASSACHUSETT3 UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY South Yarmouthn MA DAT=10131/2013 PERMIT A PZY— 30 JOBSITE ADDRESS, ou' 1I ✓U AA n kVC n kI (Z- OWNER`SNAMEMQn CP OWNER ADDRESS -&A l d r,21f FMZJL_ OCCUPANCY TYPE COMMERCWL93 EDUCATIONAL ❑ RESIDENTIAL❑ NEW: J] RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMRTI D: YESf3 NO ❑ FIXTURES T FLOOR— BATHTUB BSM 1 2 3 4 S e 7 e e 10 1 11 12 13 11 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN I FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECT WATER HEATER ALL TYPES WATER PIPING". IDTHER , I I I IT INSURANCECOVERAGE: I ars a Qmwd 110 1 1 Insuranp policy or Ib substantial equivalent which meals the requirsawls of MGL CIL 142. YES NO ❑ F YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:1 am swan that the Beensee does not have the tmurance Coverage required by Chapter 142 of the Yamchusetb General Laws, and that my signahne on this pamit appiksWn nk" this f"Wmment CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby caay ont all a eb exelb ■rd hdarm■oon I have ■rBrnllee or entww reperdky oft apptoaon am bun and acaaa* to ym/eo beW ofmybwwWp and that all pAaMwork ing and krtalalms pab .. wxW to pemel (awed for thb appkMm me be„eo arw* *ft aB Pan�'�2../ or Ina as MWhmW b Sbm ftmbbg coat ant (Xrapier 1e2 of ate GmvW Lawn. PLUMBERS NAME 17`7e,, . N.aJr LICENSE://6Zy SIGNATURE MP ER JP ❑ CORPORATION [R/ PARTNERSHIP ❑ 0 LLC ❑ t COMPANY NAME_Comnass Plumbing & Heating Inc. ADDRESS 50 Oliver Street CRY Nnrth Fastnn STATE MA jlp 02356 TEL 508-238-3479 FAX nna-7'10-02BR CELL 508-922-6638 EMAIL mniosi@compasspiumbinginc.com i, l-P,"rL f 1-6 . COMMONWEALTH OF MASSACHUSETTS • PLUMBERS A%D GASF,TTERS LICENSED AS A J IURNEYMAN PLUMBE ! ISSUES THE ABOVE UCENSE TO: MARC A NIOSI t 20 QUARRY LN s NORTH EASTON MA L2356-P566 22538 05/01/14 15:856 COMMONWEALTH OF MASSACHUSETTS F LUMBER3 AND GASFITTERS LICENSED A•: A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: MARC A NIOS1 20 QUARRY LN ' NORTH EtCTON MA 02356-2566 11624 05,01/14 154855 1 COMMONWEALTH OF MASSACHUSETTJIN121 REGISTERED AS A PLUMBING CORPISSUES THE ABOVE LICENSE TO:MARC A NIOSI COMPASS PLUMBING & HEATING, 50 OLIVER ST �lN� SUITE 107 NORTH EASTON MA 02356-1467)Kl ' 2923 05/01/14 145832 I I CONTROL# H 3 6 3 1 2 7 IMPORTANT - N this license is lost or destroyed, notify your Board at the: Divislon of professional Llcenstae, 1000 Washington St, Suite 710, Boston, MA 02118-6100. N your name or address shown is changed, notify your board of correct name or address to insure proper marling of next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws as amended. N is a personal privilege, and must not be loaned or assigned to any other person. Keep this license on your Person or posted as required by law. CONTROL# H363126 IMPORTANT N this license is lost or destroyed, notify your Board at the: Division of Professional Lkensure, 1000 Washington St, Sutte 710, Boston, MA 0211"100, N your name or address shown is changed, notify your board of correct name or address to Insure proper mailing of next Renewal Application. Ahvays refer to your license number. This license is subject to the Provisions of the General Laws es amended. N is a personal privilege, and must not be loaned or assigned to any other Person. Keep this license on your Person or posted as required by law. CONTROL# H 3 419 8 4 IMPORTANT - N this license is lost or destroyed, notify your Board at the: 1 Division of Professional Licensrae, 1000 Washington at, Suite 710, Boston, MA 02118-6100. f N your name or address shown is changed, notify your board of correct name or address to Insure proper marling of next Renewal Application. Always refer to your license number. This license Is subject to the provisions of the General Laws as amended. N Is a personal privilege, and must not be loaned SS or assigned to any other person. Keep this license on your i person or posted as required by law. { tr. CONSTRUCTION Pe®it r e;S I \ - RE erh�tapnes e lame date. jo21W4 EXPRESS BUILDING PERMIT APPLICA TOWN OF YARMOUTH �t , Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Fad. 1261 SS: �&A9,)XIT Ale ASSESSOR'S INFORMATION: OWNER CONTRACTORgj�/ L ry A N4� 1 d K .. : r NAME MAM Nf ❑ Rmdeatiel 0 Commercial ❑ Est. Cost of Construed og �i 6(%�' L e � / . _ ter, Home Improvement Contractor IJc: # ll e j Construction Supervisor Ua # 07Qz � 0CJ Worl®m's Compensation hrsuranca (check one) 0 I am the homeowner ❑ I am the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp. Polley# WORK TO BE PERFO ❑ Tent (Far Retardant Cerdlleatr amehed) ❑ Wood Stove Shed 0 Siding: # of Sgoa= " " V O p Replacement wiadowc # . O Replac®ant ❑ m Ro-oE # of Squares v L/ 17 ❑ insulation () Shipping old shingle' () going over n Izym 'The debris will be disposed I declare under penalties of perjury that the wID be just cause for denial or rev o Appliczes Signettac Owners Signature of existing roof ❑ Old Kings ILghway/f norie Dimint Roofiugt5iding (Lake for Bite) and correct to the best of my knowledge and belie£ 1 understand that any false amwer(s) S MA.1- Ch. 269, Section 1. no / // -y / /4/ Appmved Bl"• Date•. bwldmg Offic al (or designee) Zoning Historical District ❑ Yes Cr No Flood Plain Zone 0 Yes Water Resource Protection District Within joo ft. of Wedands: ?Ycs 0 No �j Yo ❑ • No k0I N The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Buffders/Contractors/ElecMcians/Plumbers Applicant Information Please Print Lezibly Address: 'r rr Are you an employer? Check the appropriate box: Type of proles (required). 1.0 I am a employer with 4. 0 I am a general contractor and I employees (fi111 and/or part-time• have hired the sub -contractors ti. ❑ New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. 0 Demolition woddng for me in any capacity. insurance employees and have workers' comp. insuran r—t 9. ❑ Building addition [No worker' comp. required;l 5. We are a corporation and its 10.0 Mecnical repairs or additions 3. 0 I am a homeowner doing all work officer have exercised their 11.0 Phm tbing repairs or additions mysdE [No workers' camp right of exemption per MGL 12.0 Roof repairs insurance ram] t 3a. ❑ I am a bomeowneracting as a a 152, § 1(4). and we have no employees. [No workers' 13.0 Other general contractor (refer to #4) comp, ine,r,,,, Y reqahvd.] 'Any appliow that A-1- boa #1 tmta also tin our the swtkm below showing dwir wthm' eompcandosit+o&7 is M ati n. • a�oaw..nm win aura ran am�va mmc®g mey ore aomg sa wort ma ma ape ooaee eonmactm Mass aa6®t a new affidavit h.dwtiag such. lContneton that gibed: this boa — attached in addidooal sheet sbwmg the saran of the soh-anmecoo and man whedw or mat tbma wires have employees. 1f the bawe employee:, they — provide their we d=. comp. policy>®ber. . Ian an employer dhat is ptrorddatg workers' compensation dtataateefor my emplapea& Bdow ds the poUcy and fob site Informaddon. Insmimce Company Nan= Policy # or Self -ins. Lic. #:Expiration Date: Job Site Addresx City/Statermp: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). FIRM to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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 cer* under the palm and pmaldes of perjury that the Informadam prodded above dr trot and eorrrct sne Offlcld art only. Do not write In dds area, to be completed by city or town ofjdedaL City or Town: Permit/Ucense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Citylrown Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone #: Information and Instructions Massadmseaa General Laws ehaphs 152 rcquku a0 eagbydrs to provide worl=, compentadon foi tha =Pkeyea pm u a to this statute, an emWky'ee is dc6n ed u "-zvm pmaa in the Service of another noder any eouind of hire. c)cprm at implied, oral or writtm." An Ceapky r is defied to "aa W&Yidu4 parlaesS* assadadom cmpoahoa or other Lad cu ft of any two of more of the fotetomt mptad is a joint estespriee. and iochrdm= the kvl repaesccbdv of a decayed cmpbyeti a tha recei►a or ttmt t of n iadivld4 put woib* uaodadaa or otbef kpl raft cmpkU t tmpb7eea. Howerat the owns of a dwelling home baring not morn then titer apertmentr sad who rcddo -1 ' -, or the oavpd of the dwelling bmw of another who mploys pasoas to do maiasmaaeq eonsnnedm of repair wo[k on mch dwesist boom or an the pom& of building appurtenant Ifo Sb&R not becom of sack enpkymeot be deemed to be an cmpkW htGL deport Ls2. i25C(6) Glen states that "every stair K bead ►lasals; Gassy skull witbleld the Waaace er renewal of ■ Lkasse or prank to operate a buds ass or to eaastrvd bWkUM la the amomwultk ter aq appoemat wM here not produced acceptable evWaee of amp8aaa wn tie IaRssra earwsgs r9gok V AddiSoeaC7. MOL ckapes M 12XM two "Neither the cow as any of Ba political subavisiana shall ester into any contact for dw patsmaace of POM wait tmhl acceptable erideaea of eompsasen with the Stmaanea cequircmatt of this chapea have bea paamted b dw anthority." Appiksete plan ten as do wodker • eo adaa s8idarit completely. by daeeldng the boas tkae apply to your SSatadoa and, if neee:ers. supply sob-eautracmi(s) oemds). nddteaa(ea) and pions nmilics(s) along widitker � sow then site Smmeecs I hmled LiabMW CasQmiea (LLq or Limited Liabilft Permaabips (LLB � noes I err penmen. man not regoi and to earay molten' compmaadon imnmaee- If as LLC at LIP doe ban ampbyear. ■ polity is nagoiaed He advised that d a affidavit may be mbmin ed to die Depulmed of brduz f Aeodmu 6s eoo&m.tba of — mvaaga . Alm be sea a to Gip asd date the aMhrft The affidavit sbould be -I I to the ay or meae dot do applkados for the permit s license In ban regeesI L Get the Depentmmt of RdMI&ial AeddmeL Shasld you have any goesdms aepnftog the Iaw err if you as aegone I is obtas a woadses' comamados policy. pkase can the Department: at the aamnbcr lasted below. SdVintoted eat Should sofa dcir C1ty err Tews Otddab Please be scan des me affidavit k masQieta and posted k&y. Tbs Depsnamt has pesrided a speea st the boom of the &Mdevit fa you to tM act is the event tbs Ot>Sca of fmadpdow ho to eaotad you aepdfag theapplicant. please be Sure to till la the peaaiUlieen" s®I which wM be used as a aefaetta n®bae In addidon. an apptieant ties mot eAr it aadtlple For" WH se applicadow in any Owes yew, need only subm;t one eRSdevk isdSaEng coat policy in! nrmlim (if necessry) tad uadm -rob SUn Address" the applksat d =U write "aD bcsdoos la_-Icity or own}," A copy of the affidavit that has been officially stamped or end by the city or Iowa maybe provided is the appIiceat tea peodthat i radial dii&vk is as tide 16r ltmaa peosgila or licco a A now at>idvk ®t be 6W out tack ycw. Who a boons owns at cW= Is obtaining a liceme or permit not rehad to any baaineat or wmmaeisl veahas (i.e- a dog seems at peaeit to burs Imo not.) said paaon is NOT tegmre IN, , I I this affidsrit Tbs otiia of b=Wpdase would tikslo thank you is edrsnea far your tooperadas and should you ban any gnatboe. please do not besihte to give m a call Cite Department's sddtesa. tekpbnoe Gad fi= nmd� The Cotamonwrealth of Musachmetts Deputin - of Indttat<ial Accident, Other of Iirtrttatiptleas 600 Washington street Boston. MA 02111 TeL Al 617-7274900 end 406 or 14M-MASSAFE Fax Al 617-727-7749 Revised 11-22-06 qWvM:%ss gov/din TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: �/ /� Building Site Location: 04�/ /% ay G Sa !�f z. I (/ `}i Proposed ei Ia+On—(s,/t.,l)- 7�� Applicant:-'�e 1. Tel. AddressVSate Filed:/ / "Ijyou would like e-mail notification of sign off, please provide e-mail address: Gi�.c Gii t ti � /yl • GS Owner Owner / ji-6 '0'2r • Owner Tel. No.: RESMENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note. Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: PLEASE NOTE COMMENTS/CONDITIONS: Of''"AR,y TOWN Uk' YAKMUUTH o; y BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext.1261 BUILDING DEPARTMENT TOTAL DEMOLITION SIGN -OFF FORM State Building Code (780 CMR) Chapter 1, Section 112.1-Service Connections "Before a building or structure is demolished or removed, the owner or agent shall notifyaUutilities having service connections within the structure, such as water, electric, gas sewer and other connections. A permit to demolish or remove a building or structure shall not be issued until a release is obtained from the utilities, stating that their respective service connections and appurtenant equipment, such as meter and regulators, have been removed or sealed and plugged in a safe manner." "All debris shall be disposed of in accordance with 780CMR 111.5." !/ Building or Structure Location: ad V V!p Z_q P v� ci t / 1 t NS Owner's Name:_5P1',0*. Address: /lyC /r�2Y Phone: _ Contractor's Name• J�,� y Address: f� ��M t Phone: 5-;L-> S' 2 5'cL Z WS NStar. Date: By. Title: National Grid: Water Dept: Board of Health: Fire Dept.: Historic Commission: Verizon: Comcast: Date: By: Title: Date: t 117 t// v By f% , Title: I It r *I ca p% �' /' /• " Date: � '/ By: �/til�' Title: Date: ! — lb - l °/ BY JoN e- Title: �A) GI�tt By - Date: Title: Date: By: "id Ar` Title: Date: d �4 s /r—, By: /v Title: Conservation: Date: By: t" A&u4 - Title: U &. F APPROVED JAN 11�76 2014 10113 SEEN BROWN LIN 6 December 2013 RECEy•.ED JAN 1:; 2014 BUILDING C rR°ATMENT Mark Grylls, Building Commissioner Town of Yarmouth 1146 Route 28 ENUCCIO & RABER ARCHITECTS, INC. South Yarmouth, MA 02664 3 Submittal of Controlled Cons ction Report No.1 Flax Pond Phase II — Restroom g Addition & New Septic Control Building Construction activities have been underway at the subject project since mid -October. Over this time the following activities have taken place: I. Site clearing and mobilization 2. General excavation and preparation for building footings and septic components 3. Septic leaching and underground structures have been installed 4. Footings, foundations and slabs have been completed for both the addition and the septic control building 5. Rough Framing work has just recently begun Briggs Engineering & Testing has been retained for testing. Their reports are attached to this construction progress report. Also attached are delivery slips from the concrete pours. We have been conducting job site meetings every other week to monitor work in progress and adherence to the construction documents. All work completed to date has been done in a good and workmanlike manner and in accordance with the construction documents. In addition to the testing reports noted above I have attached progress photographs for your reference. If you have any questions, please feel free to contact me at any time. Sincerely, Tim Sawyer CC: Pat Armstrong (Town of Yarmouth) George Allaire (Town of Yarmouth) Dick Court (Town of Yarmouth) Damon Burchill (RBO) Rick Fenuccio (BLF&R Architects, Inc.) 203 WILLOW STREET SUTE A PH 508J62-8382 VARMOUTHPORT MA 02675 FAX 5OB-3U-2828 VAMCAPEARCHTECTS.COM BR���S Briggs Engineering & Testing A Division of PK Associates, Inc 0r CONCRETE PLACEMENT INSPECTION PROJECT: FLAX POND/ YARMOUTH PROJECT#: 27323 INSPECTOR: Jon Randolph PAGE OF DATE: 11/06/13 CODE C26 TEMP_ H 54F L WIND.:L H HUMID: H L CLEAR Concrete Source: Cape Cod Ready Mix General Contractor. Storage Location: Curing Box: Other. trailer Inspection completed as per ACI-301 and Contract Documents. A checklist of major items is presented. All items in non-conformance are either corrected during inspection or noted herein. Detailed inspection of reinforcing for sae, quantity, grade, spacing and configuration Is reported separately when performed. Preplacement.• Weather X Steel arrangement X Temp. X Steel clearance X Forms for general requirements. X Steel cleanliness X Grade preparation X Steel supports X Placement: Concrete placed within limits of ASTM C-94 and Contract Documents. Non-compliance items are either corrected before placement or noted herein. Concrete sampled in accordance with ASTM C-172. Unless otherwise noted all tests were conducted in accordance with ASTM's C31, C138, C143, C173, C 231 and C1064 respectively. ASTM C-94 Limits ASTM C-94 Limits Time Limits X 1-1/2 hrs. max. Temperature X SO-90' F Slump X 3 - 5' Mixing N/A 70-300 Rev. Air content X 4.5 - 7.5% Density VITA—t 3 p cf. Location: Restroom addition wails and septic tank room walls Remarks: The following is a list of all trucks sampled. Al other trucks were verified to be in conformance with ASTM C94 and Project specifications Any trucks not in compliance with standards may be tested and are noted herein. Method of placement: Chute X Pump Other Total Cubic Yards Placed 16 Load No. Arr. Time Truck No. No. al Yds. Mix Duration min. Cons emp. 'F Slump (in.) Air (%) Air Tern 'F Conc. Strength Deliv. Conk Strength Re 'red CA Size JjIL Cyl. Fabr. Set # Gals. added waterl Unit Weight (pcf) 1 2:30 83 8 70 1 56F 4" 5.3% 54F 3000 3000 3/4 5 1 10 X 100 Weymouth St., Unit B-1, Rockland, Ma 02370 100 Pound Rd., Cumberland, RI 02864 Approved: c.pJ. Rev. 3, 07 Director of Field Operations: Sean Skorohod YT Concrete Cylinder Test Results CF-11 AM&L BRIIGGS Briggs Engineering de Testing Project: FlaxPorKWarrnouth .Cobb..�•c.u.rbr.r. hr. Project No.: 27323 Date: 11 /6/2013 V Client: Robert B. Our Co. Placement Restroom Walls; Septic Tank Room Walls Location: Sample Location Septic Tank / Remarks: Coruxete sampics obtained.fa6deated and tested In accordance with ASTM C172, C31,C39, C143, C173, C231, C138, a C1064 unless otherwise noted. Concrete Source: Cape Cod Ready Mix General Contractor. Seaver Construction Mix I.D.: 3/4" - no mix No. Ticket No-, 68622 Time of Test: 2:35 Cement / Pozzolan Type: Strength Delivered 3000 Load No.: 1 Cement, Ibs: Strength Required: 3000 Set No: 1 Pozzolan, ms: Truck No.: 83 No. of Cyl-- 5 Fine Aggregate, Ibs.: Batch Time: 2:00 Slump, In.: 4.0 Coarse Aggregate, Ibs: Coarse Agg. Size: 3/4' Air Content, %: 5.3 Water, gals.: Density, pcf. W ter Reducer, oz.: Concrete Temp., *P S6 'r Entraining, oz.: Air Temp., *P 54 Other,1: Prepared by. Jon Randolph Other,2: Was HI / LO Therm provided? No Added a Water, gals.: 10 Curing Temp.(High / Low), Of. Was St , e environment provided in accordance with ASTM C31(60-8('F for up to 5000psi, 68-78Y for over 50DOpsi)7 Molls Loss Prevention: Caps FTime, Field Curing e, hrs-- 48 Cyl. End Preparation: C1231 Spe ' en Date Age at Diam. Height Area 'Density Max. Load Compressive Fracture Num r Tested Test (In.) (in.) (sq.ln.) (lbs✓ft3) Qbs.) Strength (psi) Type 2A 11/13/13 7DAY 4 8 12.57 138.5 30800 24SO 5 2B 12/4/13 28 4 8 12.57 137.9 0 2C 12/4113 28 4 8 12.57 138.7 0 21) 12/4/13 28 4 8 12.57 137.7 0 2E 12/4/13 HOLD 4 8 12.57 138.4 0 Results Within specifications: ❑ Yes []No 'Reported cylinder density reflects the estimated density upon receipt 0100 Weymouth St, Unit B-1, Rockland, MA 02370 Tested By: Gregory MacKay / Cert#01006690 ❑ 100 Pount Rd., Cumberland, RI 02864 Approved- CF 11, rev 5, 06 Appendix 2 OC-CTP-1 Laboratory Director. Sean P. Skorohod Page 1 KV� CAPE -COD READY MIX INC. j Main Office: P. O. Box 399, 300 Cranberry Hwy, Orleans, MA 02653 508-255-4600-508-' 75AS79•Fax 508-771-0422•Carver 800-287-5114 Concrete plants in Carver, Yarmouth, Brewster and Eastham SOLD TO: SHIP TO: Apo �.rro Sr�J IL R!:EERT P. 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UNR PRICE EXTENDED PRICE 10.W7Y .000D 3000 /4 DE3ICIT C.irpr`rz. 10.01TJ MR )tin -PANNE UATEA ' 10.007 I?W BA:t^i 4=GIIi^.3 RETURNED TO PLANT LEFT JOB FINISH IINLDADWO MWERR WAITING TIME TIMEALLOWED 3:73 TiTAL T1:t TRT TOTAL LEFT PLANT JOB START UNLOADING MINUTES TIME DUE -F.O TIMEONJOB-ARRIVED OVERTIME MIMES ' ADDITIONAL CHARGE 1 IOTALROUND TRIP TOTALATJOB UNLOADING TIME MTEOFXi PERA@ME DELAY TIME ADDR10r1AL CHARliE4 OVERTIME CHARGE Qat-: lTia:e Tic k.c� T:u.:k F!i]:C. ,'a Cu-'t.-sec tl,aroe/Ld OG3 d5 L1'O1(291? 14;41 .•j5£ 77 ;jlie CID ;k' S .RT S OUR C0_Lx111FT "CIT" 11atrcial 170 ^acq_, =ktuai Vcr "Jan. :°a:Td I ,• 14, C159 1->"590 -15 -4_6 :/a 7k) 7,071) ". 040 SO -0.4 '?+4 1,15,2 10, Ea4 1.3,8213 - 4 -O.c 41d ., 14C, •1, i 5 18 -a. ; �1Jn-1: LO t 1*, O.i 0 1, 03I I V1 tex Sc. r 2=:.L ..a 1.1.i -T.; -� c Ad-ra/.?Or, , _:,%, .2 Ci:.20 _ 5:"' 1, i Iq <YC T:416L 5h � 3.LT 9;c SC'.1 J.iCn I Load lC..00 i RctaCnEd 0.01 1 1Tlx. 81:nu 4.0..) 11ix Water 221.00 t ;'_'iu'Nat. •'L.QO A-14 UXtnC I-i'i 1'%X No/Cm 111.43 } ces CI.n oil 'A I CAPE COD READY MIX INC. 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IJ.5 :.^ Nit Sit Nr'n 01•:5 1:traJ;u-A '!-C'l•• i 3C-+.-. 2Y:..0ce' i.. ..l I tAa,; cia/cn 0.47 - / 1 L.... al:. it J —fro* -\�ZNIA �Vl-* ftks�i— —7- Aw. - V 5---3,uw;!Ww h UUUUWUU BROWN LINDQUIST FENUCCIO & RABER ARCHITECTS, INC. 13 January 2014 Mark Grylls, Building Commissioner Town of Yarmouth 1146 Route 28 131 South Yarmouth, MA 02664 Submittal of Controlled Flax Pond Phase II — RE b vpOK4 . RECEIVED ac 2014 BUILDING DEF>.RTPP-ENT Report No. 2 Addition & New Septic Control Building Construction activities have been progressing steadily since my last Controlled Construction Report in early December. Over this time the following activities have taken place: 1. Rough framing is complete and has been inspected by the structural engineer. 2. Both buildings have been made weather tight and all exterior finish materials are installed. 3. Rough MEP work is complete and has been inspected by the MEP engineers. We have been conducting job site meetings every other week to monitor work in progress and adherence to the construction documents. All work completed to date has been done in a good and workmanlike manner and in accordance with the construction documents. The structural and MEP engineers have been on site to inspect their respective rough installation and their field reports are attached. In addition to these reports I have attached progress photographs for your reference. If you have any questions, please feel free to contact me at any time. Sincerely, Tim Sawyer CC: James Brandolini (Deputy Building Commissioner, ToY) Pat Armstrong (Town of Yarmouth) George Allaire (Town of Yarmouth) Dick Court (Town of Yarmouth) Damon Burchill (RBO) Rick Fenuccio (BLF&R Architects, Inc.) 203 WILLOW STREET SLATE A YARMOUTHPORT MA D2675 PH 508-362-8382 FAX 508-362-2828 W WW.CAPEARCHITECTS.COM RVVIVIlL ALLEN & MAJOR ASSOCIATES, INC. 100 Commence Way P.O. Box 2118 Field Report #1 Woburn, (781)93 - 888-0118 Tel: (781)935�889 Fax (781) 935-2896 Client BLFR Report Date: January7, 2011 Project Flax Pond Recreation Area Phase 2 A&M Project #: 120336 Location: Yarmouth, MA Contractor. Robert B. Our Company Weather. Rainy Temperature: 52' Date of Site Visit January 6, 2014 Time: From: 11:30 am To: 12:30 pm Present at Site: Tim Sawyer (BLFR) Damon Burchill (Robert B. Our— Project Manager) Tom Spense (Robert B. Our— Superintendent) Paul Krby (A&M) Reported by: Paul Krby The building site was visited to perform a final framing inspection of the exposed wood framed stud walls, wood truss roof and interior bearing and non -bearing walls. The following was noted: 1. Reviewed installation of shear wall hold-down connectors at the base of the walls. The hold-down connectors appeared to be installed in accordance with the contract drawings and manufacturer's instructions. 2. The interior wood framed bearing walls were reviewed. The wood stud bearing wall between lines D.2 and E did not have the required five header installed as on drawing S2.1, and indicated as H226 (2-2x6). Action(s): 2.1. Remove stud blocking between the wall top plates and the wood plates over the door openings and install two 2x10 ripped to approximately a depth of 8%" to fit In the space to act as headers at four locations. civil & structural engineers • land survey m • environmental consultants • landscape architects wwwalla=jorcom A&M Pmject41203-36 January 7, 2014 2.2. The alcove 2x4 stud wall shall be revised to act as a 2x4 wood bearing wall with wood studs added directly below the wood truss bottom chords. 2.3. Install additional studs directly beneath wood truss bottom chords at each of these bearing walls. Electrical outlets shall be relocated as required. 3. The wood stud at the gable end wall adjacent to the gable vent opening was cut/notched to Install the vent Action: 3.1. Sister a 2x6 stud over the cut section. 4. Except as specifically noted herein, the work appeared to be in accordance with the structural contract drawings. The above items were reviewed with the project superintendent prior to my departure from the site. Paul F. IOrby, PE Woburn Structural Department Manager Email: PkiriNtMallenmaiorcom Page 2 or 3 A&M Project #1203-36 January7, 2014 Page 3 of 3 BIEIR ROUGH PUNCH LIST DATE: January 13, 2014 PROJECT: Flax Pond —Phase 2 BY: Chris Uniacke A Representative of this office visited the job site for the above referenced project on January 9, 2014. The purpose of the visit was to perform a rough punch list of the Mechanical, Electrical, and Plumbing Systems. In general, the work observed appears to be in accordance with the Contract Documents and State and Local Codes, except as noted herein. HVAC: 1. HVAC rough appears complete at the Lodge Building addition. 2. I-iVAC rough appears complete at the Septic Building. Electrical: 1. Electrical rough appears complete at the Lodge Building addition. 2. Electrical rough appears complete at the Septic Building. Plumbing: 1. Plumbing rough appears complete within Lodge Building addition and Septic Building. 2. Testing of sanitary and water piping was in progress at time of site visit. 3. Existing mop sink to be relocated is still in place. A hub drain should be provided at the existing sink location to receive the existing condensate line from the existing HVAC unit in the attic. 66 Main Stnxt I North Easton, Massachusetts 02356 1 T 508.230.0260 1 F 508230.0265 1 BERWBER-mincerine.com PA130971CorrespondcnecTunch List (Rough) 01.13-14 (01.09.14 V isit).doc �}� 4, \ � \.% \ I m RECEIVED DEC 09 2013 BUILDING DEPARTMENT BROWN LINDQUIST FENUCCIO & RABER 6 December 2013 Mark Grylls, Building Commissioner Town of Yarmouth 1146 Route 28 South Yarmouth, MA 02664 RE: Submittal of Controlled Construction Report No. 1 Flax Pond Phase II — Restroom Wing Addition & New Septic Control Building Dear Mr. Grylls, Construction activities have been underway at the subject project since mid -October. Over this time the following activities have taken place: 1. Site clearing and mobilization 2. General excavation and preparation for building footings and septic components 3. Septic leaching and underground structures have been installed 4. Footings, foundations and slabs have been completed for both the addition and the septic control building 5. Rough Framing work has just recently begun Briggs Engineering & Testing has been retained for testing. Their reports are attached to this construction progress report. Also attached are delivery slips from the concrete pours. We have been conducting job site meetings every other week to monitor work in progress and adherence to the construction documents. All work completed to date has been done in a good and workmanlike manner and in accordance with the construction documents. In addition to the testing reports noted above I have attached progress photographs for your reference. If you have any questions, please feel free to contact me at any time. Sincerely, Tim Sawyer CC: Pat Armstrong (Town of Yarmouth) George Allaire (Town of Yarmouth) Dick Court (Town of Yarmouth) Damon Burchill (RBO) Rick Fenuccio (BLF&R Architects, Inc.) 203 WILLOW STREET BURS A YARMOUTFPORT MA 02675 PH 508362-8382 FAX 508362-2828 C. WWW.CAPEARCHMCTS.COM 0Briggs Engineering & Testing A Division of PK Associates, Inc 0 CONCRETE PLACEMENT INSPECTION PROJECT: FLAX POND/ YARMOUTH PROJECT#: 27323 INSPECTOR Jon Randolph PAGE OF DATE: 11/06/13 CODE: C26 TEMP-* H 54F L WIND.: L H HUMID.: H L 1CLEAR Concrete Source: Cape Cod Ready Mix General Contractor. Storage Location: Curing Box: Other. trailer Inspection completed as per ACI-301 and Contract Documents. A checklist of major items Is presented. All items in non-conformance are either corrected during Inspection or noted herein. Detailed Inspection of reinforcing for size, quantity, grade, spacing and configuration is reported separately when performed. Preplacement: Weather X Steel arrangement X Temp. X Steel clearance X Forms for general requirements. X Steel cleanliness X Grade preparation X Steel supports X Placement: Concrete placed within limits of ASTM C-94 and Contract Documents. Non-compliance Items are either corrected before placement or noted herein. Concrete sampled in accordance with ASTM C-172. Unless otherwise noted all tests were conducted In accordance with ASTM's C31, C138, C143. C173, C 231 and C1064 respectively. ASTM C-94 Limits ASTM C-94 Limits Time Limits X 1-1 /2 hrs. max. Temperature X 50-90' F Slump X 3 - 5" Mining N/A 7D-300 Rev. Air content X 4.5 - 7.5% Density 3 p.cf. Location: Restmom addition wails and septic tank room walls Remarks: The following is a list of all trucks sampled. Al other trucks were verified to be in conformance with ASTM C94 and Project specifications. Any trucks not in compliance with standards may be tested and are noted herein. Method of placement: Chute X Pump Other Total Cubic Yards Placed 16 Load Arr. e re Tim Truck No. No. ol Yds. Mix Duration min. Conc. Temp. 'F Slump (in.) Air (%) Air Temp.Strength 'F Conc. Deliv. Conk Strength Re 'red CA. Size in. Cyl. Fabr. Set # Gals. added water UNt Weight 1 2:30 83 8 70 56F 4" S.3% 54F 3000 3000 3/4 5 1 10 Iq100 Weymouth St..Unit B-I, Rockland, Ma 02370 100 Pound Rd.. Qxnbedand, RI 02864 Approved: c.p.i. Rev. 3, 07 Director of Field Operations: Sean Skorohod YT Concrete Cylinder Test Results CF-11 BRtGos Briggs Engineering $ Testing Project: FlaxPond/Yarmoith NOV A Project No.: 27323 Date: 11/6/2013 Client: Robert B. Our Co. Placement Restroom Walls; Septic Tank Room Walls Location: Sample Location Septic Tank / Remarks: Concrete samples obtained,fabricated and tested in accordance wrfth ASTM C172, C31,C39, C143, C173, C231, C138, 5 C1064 unless otherw lse noted. . Concrete Source: Cape Cod Ready Mix General Contractor. Seaver Construction Mix LD.: 3/4" - no mix No. Ticket No.: 68622 Time of Test: 2:35 Cement / Pozzolan Type: Strength Delivered: 3000 Load No.: 1 Cement, Ibs: Strength Required: 3000 Set No-- 1 Pozzdan, tbs: Tuck No.: 83 No. of Cyl.: 5 Fine Aggregate, Ibs : Batch Time: 2:00 Slump, in.: 4.0 Coarse Aggregate, Ibs: Coarse Agg. Size: 3/4" Air Content, %: 5.3 Water, gals-- Density, Pcf: W ter Reducer, oz.: Concrete Temp„ 't 56 r Entraining, oz.: Air Temp., Y: 54 Other,l: Prepared by. Jon Randolph Other,2: Was HI / LO Therrn. provided? No Added ' e Water, gals.: 10 Curing Temp.(HIgh / Low). Of: Was St ge environment provided in accordance with ASTM C31(60-80'F for up to 5000psi, 6&78Y for over 500opsi)7 M Loss Prevention: Caps Feld Curing Time, hrs- 48 Cyl. End Preparation: C1231 SJcI Date Age at Diam. Height Area *Density Max. Load Compressive Fracture N Tested Test (in.) (in.) (sq.1n.) (Ibs✓ft3) (Ibs.) Strength (psi) Type 2A 11/13/13 7DAY 4 8 12.57 138S 30800 24SO 5 211 12/4/13 28 4 8 12.57 137.9 0 2C 12/4/13 28 4 8 12.57 138.7 0 2D 12/4/13 28 4 8 12.57 137.7 0 2E 12/4/13 HOLD 4 8 12.57 138.4 0 Rests is within specihtati0rs: ❑ Yes ❑ No -Reported cylinder density reflects the estimated density upon receipt M 100 Weyrnouth St, Unit B-1, Roddand, MA 02370 Tested Ely, Gregory MacKay / Cert#010066W ❑ 100 Pount Rd., Cumberland, RI 02864 ry CF-11, rev 5, 06 Appendix 2 OC-CTP-1 Laboratory Director. Sean P. Skorohod Page 1 v ' ` CAPE COD READY MIX INC. Main Office: R O. Box 399,300 Cranberry Hwy, Orleans, MA 02653 508-2554600-508-775-4679•Fax 508-771.0422•Carver SOD-287-5114 b6T Concrete plants in Carver, Yarrimth, Brewster and Easttiam SOLD TO: SHIP TO: �. Avg 1'rlD� R1:ff=7 E )UP r_]7.EXE1tTT JCE3 YARMCTJT1i 4-0. EC:C 153? - £LAX MIT) / t:LIT LCDGE �00i1069 FLIROICIt }5t 0; 849 O££ V. 1AI II 3T ,TIME FORMULA LOADSRE YARDS ORDERED DRIVER MUCK PLANT/TRANS.? •t1:3S 10.00 10.00 94 4.00 DATE - LOAD* YARDS DEL. BATCH WATER TRIM SLUMP TLCKEr NU BER 11/0If21313 _ _ 10.30 5.00 138566 WARNING IRWATINO TO THE SM AND EYES : �:� :.r�rrrlw�i N0'°'°""'°!"/A 1e id° rrlrr o�.rwrrrow.rlt♦m®mwrClrafi]v •nr,...yr.rrrrrrr�]Ir - rIrOA]rlrr,rrr.r.rrrrrr.rrrrrr .r.a.+rtr.r�....r r.+��lrr+r.lawaa.]va rrwrrrrr.r.r.r�r r...rr�r�r.rrrr,rwii DALX - WE/d/TMASTER - COU[R • A r]rwe mrmn ro can M roue. o M rMrWVW1Y'MMrM.AMI4r.uef GfJll.fAlgq. 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',I$.11'�I•l' _�'I Ji)t •l'! _'OL -Ij. 1. 1/ ] 1 • t lit/Cu ID Ai . i A;j S £. 91 0 S C: o ei.]: 0t C V�--1D CAPE COD READY MIX INC. Main Office: P. O. Box 399,300 Cranberry Hwy, Orleans, MA 02653 508-255�600.508-775.4679•Fax508-771-0422-Carver800-2875114 Concrete plants in Carver, YarrnoutlTr6rewster-and= l ncN SqI SOLD TO: II'SHIP TO: A06C:.T F. OUR .3035 •iAl itCu-7N , , ATI_s Y.O. S.i( 1575 .. mm ?OND / r1EN-LOD4e' 1nlr�w. . HARWICH 1Li GTE•:° Ur N. )LAIN 3T - 71 DLIY6riT FJ ' TIME FORMULA LOAD SIZE YARDSORDERED DRIVERNTRUCK ..PLANT/TRANS) 13:03 - d.00 15.00 INC. 4.00 DATE LOAD I YARDS DEL BATCH 0 WATER TRIM - SLUMP TICKET NUMBER 0S/2012 2 30.00 5.00 63625 WARNING wwr,rrrrr. o\.r..ron.�owr.s,Irerr.rP.a\r»� RTRITATINO TO THE SKIN AND EYES rrlaarrwwrorrr rp aw uww rrr.rr.rrrr.��\r�\w, N0Aditd9VIIq IIIArMrlh rrr rrrewar.rrrrr.r. mo,a\am mN.eTr,G\\I rn r'rar�r\rwrrr.r�rir wrier rrw rwrr rr.w.\rwr�rw rrwr \,.r,rrr\.rr,rr ^rairiirr�®CI\LIIrrMC rr.rrrrr„rrrrr.r. 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Box 399,300 Cranberry Hwy, Orleans, MA 02653 508-255.4600.508-775-4679•Fax 508-771-0422•Caryer 800-287-5114 _ Concrete plants in Carver, Yarmouth, Brewster and Eastham - t SOLD TO: Iri SHIP TO: " ! • D;3E?T B JI7'� CO. C'lElir'1' aeas - YA,'Yf'.v'UTH `� P.C. BOX 1529 �, rLAx VOM / NEW LOCCE �URtiLS HA tulelt )Li 02.61.5 _ O:-F 2:_ MIN 3T r/ 1 2- QUF^i1T r.D i C156a � TIME. FORMULA LOAD 612E YARDS ORDERED _ r18Ufx- , - PLANT/TRANS) 1C�55 DATE LOAD / YARDS DEL. BATCH I WATER TRIM . SLUMP TICKET NUMBER 11,10f/2a1S 1 13.00 3.00 GIC22 WARNING {ve.rrarrr{r F+�v{.w.rl{ow`..ArrMwr.{{erwrr. IRRITATING TO THE SKIN AND EYES �e:��' ::r0�.`�„ KO Added MIr°wTAvtrr'°y fwr.Ir.rva rAr wrr{.I.AOIYm mmcrrc.uv •.. r,rrr...rrr.rrrrrr.• wwa ar rr. r.,. r.{rr{rrrrrr•rr�rr rr.rrr.rrr.,.rrrrrrr CALL grr{wyy.r.roeeeee {rr.r r.w`U` r . TY{rprr.rrYrwr•.nr.• WEIGHTMASTER WIIWT{ a.e+{{NAr{ OWaDT',ro !Edl. 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'...�...�.. - Y � � � ' y . 1 '(�L � � � _ ` Y � �j` � •� ' ` '�I-� r BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. Town of Marnunnh Building Department 1146 Rotate 28 • 1:Innouth, JIA 02(;64-N92 Tel: 508-399-2231 ext. 1261 Fax 508-398-0936 Office Use On "I Planning Board Information Assessors Department Information: Map or Permit No. Dateq-jZ& Type Permit Permit Fee S n emend Date /� Recording Date New ✓/ ` Deposit Rec'd. a 1J �./ _ PI;m No 1.4 Property Dimensions: Net Due $ other Lot Area (sf) F ontags (it) Lot Coverage This Section for Office Use Only Building Pe Nu ber. Date Issued: Certittcate of Occupancy Signature: Bupdng Offidal Date Is Is not required Section 1 - Site Information 1.1 Property Address: 1.2 Zoning IMormedon: -51 'DuQoNr AYG. L1 r�\J $0 eril `/A2t0ACvn4 MA Zoni g District Proposed Use 1.3 Building setbacks (n) Front Yard Side Yards Rear Yard Required I Provided Required I Provided Recruited I Pr&Mpd 1A Water Supply (et.O.L a 40. S 541 15 Flood Zorn lnromutforc Comer w is Public Private Zone BFE: Section 2 - Property Ownershi Authorized Agent 2.1 Owner Ord: owAl Ma-M�oum "A Name Mailing Address_ Telephone Hann (print) r0 1D �1� r Mailing Address: Qmuvn ,a - wnsuucugo cierAceal 3.r1-�Llcensod Construction ntion Supery - ✓ P' Wt O f-1 00 rL C H I LL.. ,S3 SItoRT jqky r W.`//i2wt OM M/k 02(013 Address al r1r m, Ogg $ Signature Telephone Not Applicable I_J . GS — 0G83e License Number 1 of 4 OVER 3.2 Registered Home Improvement Contractor. Company Name roP&%kt Wt912a¢!J XP Rv�eRT Du(Z Co., ��� �"t'"'4 o2bys Nol Appficabk ❑ Registration Number Addressi-AM ' J500 Ltu. 05'1>,O Expiration Date SI iure Telephone 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 - Professional Design and Constriction Services - for Buildings and Strictures Subject to Constriction Control Pursuant to 780 CMR 116 (containing more than 35,000 c.f. of enclosed space) Section 5.1 Registered Architect Nd ApplobN ❑ Name (ReglatraMlr Registration NurrMr Address signature Telephone Eap1raMn Date Section 5.2 Registered Professional F-n inee s Name' Arse of RasporMURy - Address signature Telephone Regisbedon NunEar Ermeation Dais Name Area Of Respara" Address - - Signature Telephone Regft No lhmibN - Expiration Wu Name - Area d Respdaibaey Address Signature Telephone Regft son Ntxmw Erik~ Date - Name Area of RespaviMity Address Signature Telephone Registration Number Expiration Data Section 5.3 General Contractor tyeR.` O_ Out CAP. Not Applicable ❑ . Company Name Pers�tR sporisibleforconsbuctlon rT/t'(Lc✓(cr-t r 2`( ?2�ir1- Wt�TmJV P� Ad Siena hod- $2, 0530 - Telephone a 2 of Section 6 - Description of Proposed Work (check all applicable) New Construction (tor multiple family only ) No. of Bedrooms (for mutfiple family only) No. of Bathrooms Ex sting Bldg. >� Repair(s) ❑ Alterations ❑ Addition Accessory Bldg. ❑ Type Demolition �!A)e f1'/ZG Other Specify: Brief Description of Proposed Work: t W RESTRco App I n o ft-Ax Port) t oD 8 g[-Ab p6w nc. S T_13M Cef•)Tlzo1- rlvo/U G/ _ 45;�1, tiu olky', a- pLe4t1Z LL4 c. Section 7 - Use Group and Constriction Type Building Use Group (Check as applicapabfe) Constriction Type A ASSEMBLY ❑ A•1 ❑ AJ ❑ A-2 ❑ A•$ ❑ A.'! to ❑ 1e ❑ B BUSINESS ❑ 2A ❑ 29 ❑ 2C ❑ E EDUCATIONAL ❑ F FACTORY ❑ F•1 ❑ F•2 H HIGH HAZARD ❑ 3A ❑ 39 ❑ 1 INSTRVTIONAL ❑ 1-1 ❑ 1-2 ❑ 1.3 ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R•1 ❑ R-2 ❑ R-3 ❑ SA ❑ SB 5 STORAGE ❑ S•t ❑ S-2 ❑ U UTILITY ❑ SPECIFY. SPECIFY: SPECIFY. M MIXED USE ❑ S SPECIALUSE ❑ Complete this section if exEsWg building undergoing renovations, additions and/or change Iri use. Existing use Group: A Existing Hazard Index 780 CUR 34 Proposexi Use Grey_ A 3 Proposed Hazard Index 780 CUR 34 Section 8 Bugdina Height and Area Building Area Exis&V (f applicable) Proposed - NurrOw a floors or stories Irx2u I lalsemerb lerale 1 F" 0 fz Flow Me per Floor (s0 3 i0 �jO Total Area AO Fklors (sf) �p Total Height (R) 7-f- Section 9 - STRUCTURAL PEER REVIEW (780CMR 11011) IrldependeM Sbuctural Engineering Sbucbrral Peer Review Required Yes „„.._.. No ..... __. SECTION 10a OWNER AUTHORIZATION -TO BE COMPLETED WHEN FOR BUILDING PERMITS as Owner of the subject property, hereby au ` I f7 to act on ;my be n a tiers relative to work authorized by this building permit application. 9l /5 re of owner Date - 3 of OVER AUTHORIZED AGENT I, , as Owner/Authorized Agent hereby declare that the statements and Information on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 'PA-Yu.o N 7GVC4- 41 U- t?.n6,5r . F2 (10-, 1AX . . Print Name Signature of O Section 11 - nem 2. EtaCV tal 3. Pkcbft / Gas 4. L%darkW MAC) S. Ftre Pwtettbn a. Tatll.(t ♦ 2. 7♦ 4♦5) 7_Toal Sarre R. rw�m EsdrMted Cost (Dollar,) to be COMvMed by Dam appkart Check Below ❑ Conservation -Commission Filing (d applicable) ❑ Old Kings Highway 6 Hlstorkal Commission approval (d applicable) Date 4014 The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses B i s iness/Organization Address: V.0 Coy/StoteMp: tactrwit-fit, 6. 046K Phone#: :9r'10,}—Mo Arey a n employer? Check ktote, appropriate box: 1. I am a employer with employees (full and/ or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp, insurance required] 3. ❑ We are a corporation and its officers have exercised their right of exemption per c. 152, § 1(4), and we have no employees. [No workers' comp, insurance required]' 4. ❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] Business Type (required): 5. ❑ Retail 6. ❑ Restaurant/Bar/Eating Establishment 7. ❑ Office and/or Sales (incl. real estate, auto, etc.) S. ❑ Non-profit 9. ❑ Entertainment 10.❑ Manufacturing 11.❑ Health Care 12.❑ Other - -nny applicant mar checks box G must also fill out the section below showing their workers' compensation polity Information. "If thecorponte officen have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organiation should check box 01. lam at employer that it providi workers' censation ins`VV'' formy employees Below is the policy information. Insurance Company Name: Cttda N NrRhGG t-Oh12A^44 Insurer's City/SlaterLip: P6 . 6,1U 4*1k 017 Policy# or Self -ins. Lic. # 1JM 031 V -]L 7 I I Expiration Date: ! / Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure wverage as r ed under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to $1, 000.00 and/or on - ear irnprisonmen% as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day ag ' e violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of a DIA f I¢ ance coverage verification I do hereby cwOf3b a and penalker of pepary that the information provided above is true and correct i nature•te: 11 Ih ne#• Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office 6. Other Phone www.mascgov/dia coY PLEASE PRINT.• job Location: 8 TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM Number Owner of Property. Construction Supervisor. VMtAOA Name 4c • yatz.�xi✓f71 to u I-H 70 me rf l "l S - 0G9 *0+{- '774 836 0 License Address: � ' tr"12�T W/°Rf W. yh RNityaT -, Wi A 02(c•4- sj 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, I&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 anyother 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: 1 have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ No ❑ If you have checked Yn please indicate the type coverage by checking the appropriate box. A liability Insurance policy .❑ Other type of Indemnity ❑ Bond ❑ OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General laws, and that my signature on this permit application waives this requirement Check one: Signature of Owner or Owners Agent Owner Agent �] Signature: 1"- 1 Building Official Approval: TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, )VIA 02664 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.GL Chapter 40, Section 54 and 780 CMR. Chapter 1, Section It 1.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 31 —VVfeOf A4C - S . YKX+v "rH , µ,{A — Work Address Is to be disposed of at the following location: Oo l-K �Wt, Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Application Permit No. b Date Massachusetts - Department of Public Safet� Board of Building Regulations and Standards 0-norurlion Supenkor License: CS-068304 �' DAMON A BURCIIIL s L 33 SFIORT WAYS i . W YARTMOUTIi MA10 Expiration Commissioner 05/0812014 J r:linnta' 191n11 7aTTzTwv1 THIN .ACORD. CERTIFICATE OF LIABILITY INSURANCE °"'EPAWDON 9/182013612013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER IMPORTANT: If the cartO)cate holder Is an ADDITIONAL INSURED, the policy0m) must be endorsed. if SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the ceNflcafe holder In lieu of such endorsement(s). PRODUCER HUB International New England 222 Milliken Blvd Fall River, MA 02722 506235-2200 k4TEACT: Suzle Proubt ,1,c ,4 EA: 508-235-2207 w r. 836$41-4930 Eau". , susan.proulx@hubintemational.com INSURER(S)AFFORDINGCOVERAGE NsuERA:AolaInsurance Company 31325 INSURED t Our Co., Inc. 24 Great Road NSURERa: Continental Western Insurance C 10804 NSURERc: Chartis Specialty Ins Co 26883 INSURER D; Firemen's Ins Co Washington DC 21784 P.O.Gnat 1539 P.Box 1539 Harwich, MA 02645 INSURERS: INSURER F. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. L R TYPE OF INSURANCE hDDL PIIMLMa sum POLICY NUMBER E� m UNITS A GENERALuAexmY X COMMERCIAL GENERALLIABXnY CAMS -MADE ❑X OcwR CPA130142820 121011201212101201 EACHHoceuNRENeE s/000000 M $250000 NED E)M P47 arse t5 000 PERSONAL s ADV NARY S1.000.000 GENERAL AGGREGATE s2,000,000 GENT. AGGREGATE rouev LIMIT APPLIES PER, Fx1 �- Fx-1 Loc PRooucm-CoNP,oP AGO s2,000,000 s p AUTOMOBILE Luaam X ANY AUTO ALL OWNED sC14EDUEo AUTOS AUTOS X HIVED AUTOS X NON4 NEDAUTO MAA130144020 1210112012 12101201 COMBINED SINGLE LOST E, accklmIJ $1,000,000 BODILY RULRY(PwP ) s BODILY NANRY(PwauidwO s IPW°PE s t A X UM RELLAUU EXCESS MAR X OCCUR p.MADE CUA130142920 21012012 12/01201 EACH OCCURRENCE $10000.000 AGGREGATE t1 O 00O 000 DED I I RETENTIDN s B NORIIERs COMPENSATION AND EMPLOYERS ULABLITYFR ANY PaoPRIETORNARrNEF)OECUTNE O:FICEMA ET E>un �mcn7 Y(YYaan�de"H NH) DESCRIPTd M10N OFOPERATIONSb.10. MIA WCA031676712 011101120113 01/101201 X NG 6TATU- OTH- El EACH ACCIDENT SS00 000 E.L DISEASE -EA EMKOYEEJ $500000 EL DISEASE -POLICY LIMIT 1;500000 C A Pollution equipment CPOBO87906 CPA130142820 2101/2011 211111/2012 12/0112013 IMIM011 $1,000,0001$2,000,000 leased/rented $500 0001$1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES lAmdM ACORD 101, A&%WW RNM,b SdnBd,. N„M,,,po Y mead) Project Flax Pond Building Permit Town of Yarmouth MA Is named as additional Insured for the project referenced as required by written contact. Town of Yarmouth SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOME WILL BE DELIVERED IN 1146 Route 28 ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth, MA 02664-0000 AUTIOOgD REPRESENTATIVES, {. C 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 2S (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD 2S987604IM824927 SP002 TOWN OF YARMOUTH Building Department Town Han Yarmouth, MA 026U (508)398.2231 ext1261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-14-111 Applicant Name: Damon Burchill Applicant Phone: 5084320530 Building Location: 0031 DUPONT AVE Owner's Name: FLAX POND RECREATION Owner's Addres 1146 Route 28 South Yarmouth MA 02664 Owner's Telephone: (508) 398-2231 REVIEWED BY: (OFFICE USE ONLY Recorded By. IC Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 9/182013 Issue Date: Expiration Date Comments: Map/Lot: 100.1 construct new restroom addition to Flax Pond Lodge Bldg. 1. WATER DEPARTMENT: DATE: WA: 2. ENGINEERING DEPARTMENT: DATE: WA: 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: DATE: WA: 5. BUILDING DEPARTMENT: DATE: WA: 6. FIRE DEPARTMENT: DATE: WA: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 9/192013 ate k� TOWN OF YARMOUTH 3= c HEALTH DEPARTMENT ��•y�� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 31 No.: So f g72Z 0536 Address: t4►E}2t.t.W t t;- 4 Date ••Ifyou would like e-mail notification ofsign off. please provide e-mail address: Owner RESIDENTIAL AND/OR COMMERCIAL BUILDING rV% HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: PLEASE NOTE COMMENTS/CONDITIONS: .TE: `j 1 6li �_ r"1t S MGL AND FIRE _ TOWN OF YARMOUTH I REVIEWED FOR CODE COMPLIANCE. far ERRORS OR OMMISSIONS DO NOT RELIEVE \ THE APPLICANT FROM THE RESPONSIBILITY OF OAS But T C qIPLIANCE. CY 19 INSPECTOR YARMOUTH FIRE & RESCUE Commercial Building Permit Sign Off Project Name:Flaa Pond Phase II Address: 31 Dupont Ave. Contact Name:Damon Burchill Phone #774-836-0993 Y NO NA Subject Regulation E S ®I El I El I Access for Fire Apparatus 527 CMR 25.02 Building Numbers MGL Chapter 148 sec 59 *Flammable gas/liquid storage 527 CMR 14.03 Fire Lanes 527 CMR 10.03(10) *Service Stations 527 CMR 5 & 9 •11azardous Alaterials Storage 527 CMR 25.08 •KNchen 6choust systems 780 CMR, 527 CMR 10.03(8) Extinguishers 527 CMR 10.02, Chapter 148 sec 28 *Fire Alarm Systems/Co detection 780 CMR, Chapter 148, 527 CMR 24,CMR 31 *LPG Storage Chapter 148 sec 9,1028 & 527 CMR 6 Pesticide Storage 527 CMR 37 *Sprinkler Systems 780 CMR & Chapter 148 sec 26 A -I Storage inside/outside Buildings 527 CMR 10.03(5) *upholstery 527 CMR 29 •Trash Containers 527 CMR 10.04 & 34 Any Hazard to the Public Chapter 148 sec 28 *Curtains, Draperies, Blinds 527 CMR 21 Description of planned projectlother requirements: Construction of Phase II of the Flax Pond Recreation Building. The construction will consist of a Est. 1471 Sq. Ft. addition of bathrooms, office and camp store. An unattached building will be constructed for the treatment of sewer. Fire Department Requires: 1. Fire Alarm plan and permit application before any fire alarm system components area installed. Fire Alarm plans submitted in construction drawings are not adequate and do not provide proper coverage and are not acceptable for permitting. 2. Code review of what fire protection requirements will be needed for the sewer treatment building. YFD permit required -depending on occupancy and submittal Plan Reviewed By: Captain ArmstrongA-M" W,earstra-Tf Date:9/17/13 Copy for Applicant® Copy to Building Dept.® Copy to Fire Prevention _.. ` Initial Construction Control Document TJ To be submitted with the building permit application by a Registered Design Professional for work per the 8m edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: Restroom Addition to the Flax Pond Lodge Building Date: 09-05-2013 Property Address: 31 Dupont Ave. S. Yarmouth MA Project: Check (x) one or both as applicable: X New construction X Existing Construction Project description: New addition to Flax Pond Lodge Building & New Septic System Control Building. Including new Advanced Septic System as specified on Brown Lindquist Fenuccio & Raber Architects, Inc. architectural drawings and specifications dated July 31, 2013. I Timothy R. Sawyer MA Registration Number. 503" Expiration date: 08-31-2014 , am a registered design professional, and hereby certify that I have Frepared or directly supervised the preparation of all design plans, computations and specifications concerning Entire Project X Architectural Structural Fire Protection Electrical Other. Mechanical for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. When required by the building official, I shall submit field/progress reports (see item 3.) together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a 'Final Construction Control Enter in the space to the right a "wet' or electronic signature and seal: Phone number. Building Official Name: Email: tim(a)capearchitects.com Permit No.: Date: Building Official Use Only A No. 50399 Note 1. Indicate with an'x' project design plans, computations and specifications that you prepared or directly supervised. If 'other' is chosen, provide a description. Trial Version 10 09 2012 CONSTRUCTION CONTROL AFFIDAVIT PROJECT NUMBER: 1203-36 PROJECT TITLE: Flax Pond Recreation Area PROJECT LOCATION: 31 Dupont Ave. South Yarmouth, Massachusetts NAME OF BUILDING: Lodge Building SCOPE OF PROJECT: Structural Desizn and Construction Administration of Proposed Lodge Building In accordance with Section 116.0 of the Massachusetts State Building Code P Edition,1, Paul F. Kirby, P.E., Massachusetts Registration No. 35313 being a registered professional structural engineer hereby certify that the necessary professional services have been performed by myself or my representatives under my review and either myself or my representatives have been present on the construction site on a regular and periodic basis and have been responsible for the following as specified in Section 1162.2: 1. Review, for conformance to the design concept, structural shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the structural quality control procedures for all code required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with the progress and the quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. I certify at this time that the structural components of the project have been satisfactorily completed in accordance with the requirements of the Commonwealth of Massachusetts State Building Code 8'" Edition, to the best of my knowledge and belief, based on construction observation and review services performed and described herein and based upon my review of material and geotechnical testing and investigation reports (carved out by others). 0 1mF1B� Yfp�1M�Mt. Signature N Sub 'bed ands ro to before me this �� day of 20-0 U.114 DEBORAH A• DELSAPIO mnwtw�tal� o(Massauhust!is NOTARY PUBLIC IEsi��ttWpSi71.18. r •' Initial Construction Control Document To be submitted with the Building Permit Application by a Registered Design Professional for work per the 8 Edition of the Massachusetts State Building Code, UIT 780 CMR, Section 107.61 Project Title: Proposed Lodge BuildingR Flax Pond Recreational Area Phase II Date: August 26.2013 Property Address: 383 North Main Street — South Yarmouth. Massachusetts Project: Check One or Both as applicable: (X) New Construction ( ) Existing Construction Project Description: Addition to the Lodge building. I, Steven A. Koran, PE, LEED AP BD+C. MA Registration Number. 34989 Expiration Date: 06/30/2014 am a Registered Design Professional, and hereby certify that I will prepare or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Architectural [ ] Structural [-] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other. [ for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this Code and the design concept, shop drawings, samples and other submittals by the Contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this Code. When required by the Building Official, I shall submit field/progress reports (see Item 3.) together with pertinent comments, in a form acceptable to the Building Official. Upon completion of the work, I shall submit to the Building Official a `Final Construction Control Enter in the space to the right a -wct^ or electronic signature and seal: Phone Number. _(508) 230-0260 Email: skaron(aber-engineering.com Building Official Use Only Building Official Name: Permit No.: Date: Initial Construction Control Document To be submitted with the Building Permit Application by a Registered Design Professional for work per the 8 Edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: Proposed Lodge Building (a) Flax Pond Recreational Area Phase 11 Date: August 26.2013 Property Address: 393 North Main Street — South Yarmouth. Massachusetts Project: Check One or Both as Applicable: (X) New Construction ( ) Existing Construction Project Description: Addition to the Lodge building. I, Marc R. Plante, PE, MA Registration Number. 38119 Expiration Date: 06130/2014am a Registered Design Professional, and hereby certify that I will prepare or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Architectural [ ] Fire Protection [] Structural ['i Electrical 0 Mechanical [ ] Other. [ for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this Code and the design concept, shop drawings, samples and other submittals by the Contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this Code. When required by the Building Official, I shall submit field/progress reports (see Item 3.) together with pertinent comments, in a form acceptable to the Building Official. Upon completion of the work, I shall submit to the Building Official a `Final Construction Control D Enter in the space to the right a "wet' or electronic signature and seal: Phone Number. (508) 230-0260 Email: mplante(a)ber-engineerine.com Building Official Use Only Building Official Name: Permit No.: Date: Initial Construction Control Document To be submitted with the Building Permit Application by a Registered Design Professional for work per the S Edition of the Massachusetts State Building Code, Ulf 780 CMR, Section 107.62 Project Title: Proposed Lodge Building0a Flax Pond Recreational Area Phase II Date: August 26.2013 Property Address: 383 North Main Street — South Yarmouth. Massachusetts Project Check One or Both as applicable: (X) New Construction ( ) Existing Construction Project Description: Addition to the Lodge building. I, Steven A. Karan. PE. LEED AP BD+C, MA Registration Number. 34989 Expiration Date: 06/30/2014 am a Registered Design Professional, and hereby certify that I will prepare or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical ] Other. [Plumbing] for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this Code and the design concept, shop drawings, samples and other submittals by the Contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this Code. When required by the Building Official, I shall submit field/progress reports (see Item 3.) together with pertinent comments, in a form acceptable to the Building Official. Upon completion of the work, I shall submit to the Building Official a `Final Construction Control Enter in the space to the right a "wet" or electronic signature and seal: Phone Number. _ (508) 230-0260 Email: skaran(a)ber-eneineerine.com Building OnicW Use Only Building Official Name: — Permit No.: Date: KARAN MECHANICAL , No. 34M _ COMcheck Software Version 3.9.2 Envelope Compliance Certificate 2009 IECC Section 1: Project Information Project Type: Addition Project Title: PROPOSED LODGE BUILDING - PHASE TWO Construction Site: FLAX POND RECREATION AREA 31DUPONTAVENUE SOUTH YARMOUTH. MA 02664 Owner/Agent TOWN OF YARMOUTH. MA 1146 ROUTE 28 SOUTH YARMOUTH, MA 02664 508-398-2231 Section 2: General Information Building Location (for weather delay YarmoutkMassachuseW Climate Zane: 5a Building Space Conditioning Type(sj: Nonresidential Ver&al Glazing / Wall Area PcL: 7% Advlt Mrpt(sI Flo"Area Office am Section 3: Requirements Checklist Designer/Contractor. TIM SAWYER BLFR ARCHITECTS. INC. 203 WILLOW ST SUITE A YARMOUTHPORT, MA 02675 508J82-8382 X 17 TIM@CAPEARCHITECTS.COM Envelope PASSES: Design 3% better than code. I CllmateSpectfic Requirements: Component Name/Description Gross cavity Cont. Proposed Budget Area or Parimeta R Valus R Value U-Factor Ufactorls) Floor 1: SlabQ►Grade:Unhoated, Horizontal[ with vertical >= 4 8. 132 — 10.0 — — Edarbr Walt /: Woud-Fran 16* o.c. 765 21.0 3.8 0.048 0.064 Window 1: Wood Frema:Double Pena with Low-E. Clear, SHGC 32 — — 0.300 0.350 0.32 Door 1: Glass (> 50% glazirgrMetal Frame, Entrance Door, SHGC 21 — — 0.5W 0.800 0.42 Rod 1: Attic Roof with Wood Joists am 38.0 0.0 0.027 0.027 (a) Budget U-factors are used for software Iasenne calculations ONLY, and we not code requirements. Air Leakage, Component Certiftcation, and Vapor Retarder Requirements: ❑ 1. An jams and pmetadom are caulked, gasketed or covered with a moisture vapor-pemxkd le wrapping material Installed In accordance with the manufacturers Installation Instructions. O 2. Windows, doors, and skylights certified as meeting leakage requirements. ❑ 3. Component R-values 3 U-factors labeled as certified. ❑ 4. No rod Insulation Is Installed on a suspended ceiling with removable coiling panels. 5. 'Otiter components have supporting documentation for proposed U-Factors. 6. Insulation Installed according to manufacturers Instructions. in substantial contact with the surface being Iwlated, and In a manner that achieves the rated R-value without compressing the Insulation. O 7. Stair. elevator shaft vents, and other outdoor air hake artd exhaust openings In the building envelope are equipped with motorized Project Title: PROPOSED LODGE BUILDING - PHASE TWO Report date: 09A5/13 Data filename: H:\_Current ProjectAMuricipaWlau Pad Phase 21FLAXPOND-PHASE TWO.cck Page 1 of 2 p B. Cargo doors and loading dock doors are weather sealed. . l] 9. Recessed lighting tidnres Installed In the building envelope are Type IC rated as meeting ASTM E293. are sealed with gasket or cakik. ' b 1o.Buung entrance doors have a vesutmute "Apped with seStJosig dwoes. aceptlons ❑ Building entrances with revolving doors. ❑ Doors not intended to be wed as a building entrance. ❑ Doors that open directly from a space less than M sq. R In area. ❑ Doors used prinrmily lo facilitate veNaiar navemard or materials handling and adjacent personnel doors. ❑ Doors opening directly from a sleepingldwelling unit Section 4: Compliance Statement Compliance Statement The proposed envelope design represented in this doaarent Is consistent with the IxMng plans. specifications and other calaiatiors submitted with this pemit application. The Proposed envelope system has been designed to meet the 2DO9 IECC morements In COMdreck Version 3.92 and to comply with the mandatory requtrdnenls In the Requkenants CtaW �i� �� JL - �92GIfITRU l Name -Title Sig lu D .VA wJ�- Project Title: PROPOSED LODGE BUILDING - PHASE TWO Report date: O9Io5113 Data filename: H.1 Current PnojectslMkWdpal fl Pond Phase 2TLAXPOND-PHASE TWO.M* Page 2 of 2 COMcheck Software Version 3.9.2 Interior Lighting Compliance Certificate 2009 IECC Section 1: Project Information Project Type: Addltlon Project We : Flax Pond Septic Control Building Construction Site: Owner/Agent 383 North Main Street Town of Yarmouth South Yannoutir, MA Yarmouth, MA Section 2: Interior Lighting and Power Calculation A Area Category Designer/Contr. B C D Floor Area Allowed Allowed Watts (ft2) Watts / ft2 (B x C) Recreation Area Septic System Pump Bldg (Workshop) 160 1.4 224 Total Allowed Watts = 224 Section 3: Interior Lighting Fixture Schedule A B C D E Fixture ID : Description I Lamp I Wattage Per Lamp I Ballast Lamps/ 0 of Fixture (C X D) Fixture Fixtures Watt Recreation Area Septic System. Pump Bldg ( Workshop 160 sq.fL) - - - - - Linear Fluorescent 1: K Surface Mounted Vaporproot 46' TS 28W., Electronic: 2 2 66 132 Linear Fluorescent 2: L• Surface Mounted Strip: 46' T5 28W: Electronic, 2 1 66 66 Total Proposed Watts = 198 Section 4: Requirements Checklist Interior Lighting PASSES: Design 12% better than code.' - Lighting Wattage: ® 1. Total proposed watts must be less than or equal to total allowed watts. Allowed Watts Proposed Watts Complies 224 198 YES Controls, Switching, and Wiring: ❑ 2. Daylight zones under skylights more than 15 feet from the perimeter have lighting controls separate from daylight zones adjacent to vertical fenestration. ❑ 3. Daylight zones have Individual lighting controls Independent from that of the general area lighting. Exceptions: ❑ Contiguous daylight zones spanning no more than two orientations are allowed to be controlled by a single controlling device. ❑ Daylight spaces enclosed by wells or ceiling height partitions and containing two or fewer light fixtures are not required to have a separate switch for general area lighting. M 4. Independent controls for each space (switddoccupancy sensor). Exceptions: 2g Areas designated as security or emergency areas that must be continuously lluMnated. Project Tile: Flax Pond Septic Control Building Data filename: P:1130970rewingsTiec%CalculabonsWghtinglSepdc System Building.odt Report date: 0=13 Page 1 of 4 ❑ Lighting In stairways or corridors that are elements of the means of egress. of 5. Master switch at entry to hotel/motel guest room. o 6. Individual dwelling units separately metered. O T. Medical task lighting or art/history display lighting claimed to be exempt from compliance has a control device Independent of tqcon of the nonexempt lighting. 8. Each space required to have a manual control also allows for reducing the connected lighting bad by at least 50 percent by either controlling all luminaires, dual switching of alternate rows of luminaires, alternate luminaires, or alternate lamps, switching the middle lamp luminaires Independently of other lamps, or switching each luminaire or each lamp. Exceptions: , M Only one luminaire in space. An occupant -sensing device controls the area. The area is a corridor, storeroom, restroorn, public lobby or sleeping unit Areas that use less than 0.6 Watts/sq.fL O 9. Automatic lighting shutoff control in buildings larger than 5,000 sq.fL Exceptions: Sleeping units, patient care areas; and spaces where automatic shutoff would endanger safety or security. tO.PhotoceNastronomical time switch on exterior lights. Exceptions: Lighting Intended for 24 hour use. 11.Tandem wined one4amp and three4amp ballasted luminaires (No single4amp ballasts). Exceptions: Electronic high -frequency ballasts; Luminaires on emergency circuits or with no available pair. Section 5: Compliance Statement Compliance Statement: The proposed lighting design represented in this document is consistent with the building plans, specifications and other calculations submitted with this permit application. The proposed lighting system has been designed to meet the 20091ECC requirements in COMcheck Version 3.92 and to comply with the mandatory requirements in the Requirements Checklist. (. DI9RaBYt19nedby5teven RBrthekrrc LC Drt mdteven R Berthektiq LC o=ounding Title 1E Date Name- +C- +c- v •�--u�u�-l�1Lk-(tee LL -ema lette@BER{n9lneerlrg_Corr� ✓� Date: 2017.0822143911-far COMcheck Software Version 3.9.2 Exterior Lighting Compliance Certificate 2009 IECC Section 1: Project Information Project Type: Addition Project Title : Flax Pond Septic Control Building Exterior Lighting Zone: 1 (Developed rural area) Construction Site: Owner/Agent Designer/Contractor. 383 North Main Street Town of Yarmouth South Yarmouth, MA Yarmouth. MA Section 2: Exterior Lighting Area/Surface Power Calculation A B C D E F Exterior ArealSurface Quantity Allowed Tradable Allowed Proposed Watts Wattage Watts Watts /Unit IBxC) Entrt Door (Main entry) 3 R of door width 20 Yes 60 56 Mechanical Area Door (Other door (not main entry)) 6 it of door width 20 Yes 120 56 Area Bghibg (Plaza area) 100 R2 0.14 Yes 14 70 Total Tradable Watts* = 194 182 Total Allowed Watts = 194 Total Allowed Supplemental Watts" = 500 Wattage tradeoffs are only allowed between tradable areas/surfaces. " A supplemental allowance equal to 500 watts may be applied toward compliance of both non -tradable and tradable areas/surfaces. Section 3: Exterior Lighting Fixture Schedule A B C D E Fbdure ID : Description I Lamp I Wattage Per Lamp I Ballast Lamps/ tt of Fixture (C X D) Fixture Fixtures Watt Compact Fluorescent 1: El: Wall Mounted Area Light Triple 4-pin 26W: Electronic: 2 1 56 56. Mechanical Area Door (Other door (not main entry) 6 R of door width}: Tradabla Wattage _Y Compact Fluorescent2: Et:_Wafl Mounted Area Light Triple "n 26W: Electronic: 2 1 56 56 @9h1b9 ( Plaza area 100rea 100 f2): Tredable Watage___ LED 1: M: Floodlight LED Panel 70W: 1�� 1 70 70 Total Tradable Proposed Watts = 182 Section 4: Requirements Checklist Lighting Wattage: ® 1. Within each non -tradable area/suriace, total proposed watts must be less than or equal to total allowed watts. Across an tradable areas/surfaces. total proposed watts must be less than or equal to total avowed waft. Compliance: Passes. Controls, Switching, and Wiring: 2. All exemption dalms are associated with ffxWres that have a control device independent of the control of the nonexempt fighting. 3. Lighting not designated for dusk-to-0awn operation Is controlled by either a a photosensor (with time switch), or an astronomical time switch. Project Tide: Flax Pond Septic Control Building Report date: 0822113 Data fiename: Pil30971DrawingslEleclCalwlatbnsWghd glSeptic System Bunding.ock Page 3 of 4 4. Lighting designated for duskloEawn operation is icon0olled by an astronomical time switch or photosensor. 5. All time switches are capable of retaining programming and the time setting during loss of power for a period of at least 10 hours. .Exterior Lighting Efficacy: 6. M exterior building grounds luminaires that operate at greater than t00W have minimum efficacy of 60 Iumenlwatt. Exceptions 0 lighting that has been claimed as exempt and Is Identified as such In Section 3 table above. Lighting that Is specifically designated as required by a health or fife safety statue, ordinance, or regulation. ❑ Emergency fighting that Is automatically off during normal building operation. Lighting that is conbDIed by motion sensor. Section 5: Compliance Statement Compliance Statement The proposed exterior fighting design represented In tics document Is consistent with the building plans, specMptlons and other calculations submitted with this permit application. The proposed fighting system has been designed to meet the 2009 IECC requirements in COMeheck Version 3.92 and to comply with the mandatory requirements in the Requirements Checklist. I Dngiklr Ygnedby Soe inns. ekmq LC 1, n DlkawSt e a lerdwkuc LC wlWldhv Engk*mWg Name -Title '&� n Date 0 tr 20120612 ISM-34-"gd Project Tile: Flax Pond Septic Control Building Report date: 09=13 Data 9iename: P:113097UXawingsTiec%CalculadortsU ightinglSeptic System Buildirg.cc k Page 4 of 4 BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR. RENOVATE, CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. To%vii oFlitrtuouth Building Department 1146 Route _t8 - 1'1nnoulh. J4\ (IY(iti4- -192 Tel: 508-399-2231 eat. 1261 Fax 50&398-0836 Office Use Only Permit NoT-Y — ate16 Planning eoard Information rpe Assessors Department Information Map Lot Permit fee $ nd s ent Date Recording Date New Deposit Reed. $ Nte _ Pl2n No. 1.4 Property Dimensions Net Due a other Lot Area Ist) Frontage (it) Lot Coverage This Section for Office Use Only Building Peffnit Number. I Date Issued: CF&11 Certificate of Occupancy Signature: /Borilil Offidar Date Is Is not required Section 1 - Site Information 1.1 Property Address 1.2 Zoning Information: ,// mow Zor4ng District Proposed Use 1.3 Building setbacks (R) Front Yard Side Yards Rear Yard Required I Provided Recruited I Provided Renrdrerl prnvWod 1A water supply (LLQJ . a Ao. s 541 1.5 Flood Zons Information: Comments Public Private Zone: BFE: Section 2 - Property Ownershi Authorized Agent 21 Owner of Record: fia'V I,, 1tD[fTl� Name (print) Mailing Address: Signature Telephone Telephone L (print c/&7aC/MaeingAddress:re Telephone Fax Section 3 - Construction Services j , 3.1 Licensed Construction supervison , ppricable 33 54v er wrap W. yhfvggv t7 License Number CS 0108304 Expiration Dat 1 of OVER 3.2 Registered Home Improvement Contractor. ' Company Name Not Applicable ❑ Registration Number Address Expiration Dale Signature Telephone Section 4 - Workers'Compensation Insurance Affidavit (MAL a 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 - Professional Design and Constriction Services - for Buildings and Strictures Subject to Constriction Control Pursuant to 780 CMR 116 (containing more than 35,000 c1 of enclosed space) Section5.1 Registered Architect Not Applicable ❑ Name (Reylatranth Registration Number Address Signature Telephone Expiration Date Section 5.2 Registered Professional Engineer(s) Name Ma of ResponsWity Address Signature Telepltorte Registration N,anber Exptitbn Dan Name Ana of Responsibility Address ygnayre Telephone Re'Numbw Expiration t>m Name Ana of aaapmmI My Address Signabae Telephone Registration Number Expiration Date Name Area of Respawbaty Address Signature Telephone Registration Number Expiration Dan Section 5.3 General Contractor Not Applicable ❑ -- company Name Person Responsible for Consttucton Address Signabus Telephone 2of4 Section 6 - Description of Proposed Work (check all applicable) New Construction ❑ (for multiple family only) No. of Bedrooms (for multiple family only) No. of Bathrooms Existing Bldg. ❑ I Repair(s) ❑ I Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify. Brief Description of Proposed Work- n �1 am ✓ evt LVO r d ra E �{- Section 7 - Use Group and Construction Type Building Use Group (Cheek as applicapable) Construction Type A ASSEMBLY ❑ A.1 ❑ Ad ❑ A-2 ❑ A-5 ❑ AJ ❑ 1A 18 ❑ ❑ B BUSINESS ❑ - 2A 2B 2C ❑ ❑ ❑ E EDUCATIONAL ❑ F FACTORY ❑ F-1 ❑ F-2 H HIGH HAZARD ❑ 3A 3B ❑ ❑ 1 INSTITUTIONAL ❑ FI ❑ 1-2 ❑ 1.3 ❑ M MERCHAIMLE ❑ 4 ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R.i ❑ SA 5B ❑ ❑ S STORAGE ❑ S•1 ❑ S-2 ❑ U UTL1TY ❑ SPECIFY: M MIXED USE (3 SPECIFY: SPECIFY: S SPECIAL USE ❑ Complete this section if exLVhg building undergoing renovations, additions and/or change In use. Existing Use Group: Existing Hazard Index 780 CMR 34 Proposed Use Grougn ' Proposed Hazard Index 780 CMR 34 Section 8 Buldina Height and Area NueOar ot floors or slides Floor Area per Floor Jet) Total Area All Floors Total Height (R) Section 9 - STRUCTURAL PEER REVIEW CMR 110 11 Independent Structural Engine*" Structural Peer Review Required Yes „_..... No. —.-- SECTION 10a OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property, hereby authorize �`� 6iy 0J to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 3 of OVER 1, VA3ay J Dt tft L(— , as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. VAMW Prim Name _ signature of O Section 11- Item Estimated Cost (Dollars) to he t orrIMed by pemta appleW 1. euu&v 2. Etetbloi 4. MaoNNnl . PueaM/Gas I (HVAL7 tl S Flre i'mW - I _ STbtal.(1+2+2+4+5) 7. Total Swan Fl. Ikrir. rvw s Waib.l I Check Below I ❑ Conservation -Commission Filing (d applicable) ❑ Old Khp Highway 3 Historical Commission approval (If applcable) 4of 4 The Commonwealth ojMassachusetts Department of Industrial Accidents Office oflnvesttgations 600 Washington Street Boston, MA 02111 •www.mass ,nVM,,v Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name Ait J l;I /State/Zi : Phone #: 50& q/ 5,z or32— Are you an employer? Cheek the appropriat�ox: 1. ❑ I am a employer with 4. I am a g general contractor and I g Type of protect (requtrcd): employees (full and/or time)! part-time).* have hired the sub -contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner_ listed on the attached sheet, 7. ❑ Remodeling ship and have no employees These sub -contractors have g, ❑ Demolition working for me in any capacity. [No workers' comp. insurance employees and have workers, comp. insurance.: 9. ❑ Building addition required;] 5. We are a e ❑ corporation and id 10. Electrical ❑ repairs or additions 3. ❑ I am a homeowner doing all work myself (No workers' comp. officers have exercised their . right of exemption per MGL 11.❑ Plumbing repairs or additions insurance required) t 3a. ❑ I am a homeowner acting as a c. 15Z 11(4), and we have no employees. [No workers' 12.0Roof repairs 13.0 Other general contractor (refer to #4) comp, insurance 1equire&I. fappGeaot that cheeks box al must also all out the section below showing thec workm- eompematiodpohev infonmtloa —..••. -..� ..o —.a s w ana wen one oumae cantrwton mug submit a new affidavit indicating such. tConttaetors that check this box must attached an additional sheet showing the same of the mb-caotruyon and state whether w am those atitics have employees. If the sub-mnaacton have employees, they must provide their worker, comp• policy tatmber. I sox an employer that Lr providing workers' compensation insaance for my employees. Below Is the policy and job site Information. Insurance Company Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/Statellip• Attach a copy of the workers' compensation policy declaration page (showing the policy number and explratlou date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal o- im prisonment penalties of a fine up to S 1,500.00 and/or one-year mprisonment, 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 pains and penahies ofpedury that the Information provided gbore Lyfrae and eormL /� r- 01)lcial use only: Do not write In this area, to be completed by city or town o.TiciaL City or Town: Permit/Ucense # issuing Authority (circle one): L Board of Health 2. Building Department 3. Cityfrown Clerk 6.Other 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: l Information and Instructions Manschn Oenerd Laws chapter 152 Minims all emplay2ra 10 provide worker' compematkm for their emP{oyeet Pursuant to this statute, an earpkyee is defined AS "—every person in tba service of another under any eostrnet of hire, express or implied, oral at written." An euplgr is defined m "ate individual, putocrshh% au9ciali°a, corporation a other legal rarity, or any two or more of the forgoing umgaged in a joint and" the kp1 repceeatstive of a deceased employs, a t!r receIva a trosta of a ind[vidusl, puboershiP, uaocletiom a tithe: kpl eafity, tmpbyimg emP Howavta the owma of a dwelling house having not morn d= three and who reside the:e>a, or the oeenpaat of thr dwelling house of anotha who employe Persona to do meiotemme e- coaattretiaa or repair work on such dwelling boom or an the pounds at building appurtenant tbaeto slur not baaum of such employment be deemed to be an employes" MOL c*w IA 125C(6)dro state that "eery stab er kcal ikeadag sgeuq shalt wlthhom the bmaae era' remawei of ■ lkeam or permit to operate ■ bo du m x is construct be0dlap In the ceassse wan ter ay appika al wM hoe not predoeed acceptable evldeaa of enmPtiamet with tba harmsm eenrage nquk l" Addidow An MOL ebaPta o p plssman e o fe work until acceptable evidence of Neither the commonwealth our any of mcomp6aoee with the; ace Bata Imo say coatis et fa the been pre public � ��g �" requirements of this chapter bave been presented Appllaets , Please eta out the worker• comrpematlam affidavit eompleby. by checking the boxes that Apply eta your sibutdom and, if may. spy sub-contractor(s) usmds). eddreu(e) and Phow onmbee(s) along with their catificsee(a) of im,mana. Limited Ciabilky CemPania (tug at Limited Liability Partnerships (LI4) with no employees other d m rho member -Orr are not required to carry wet tsr'compensation lonaanee. If An LLC or LLP doe have employee4 a policy is required Be advised the: this affidavit may be submitted to the Department of industrial Aeddeats far eoofirmsutloe of insaanee coverage Abo be ate to dge and date the affidavit. The affidavit should be returned b the city or tows flat the sppiieadoe for the permit license to bbaiing ,I �mD� of IndustrialAccidents. Should )ou have say' questions repgmdb+g compensadoa policy. pleat call the Department at the member listed below. Self-tosu nd compaaie should eater their self innmaan license sssmrbw our the appaopriata lime — City err Two Otlldale Please be sae that the affidavit is complete and primed legibly. The Department has Provided a span at the bottom of the affidavit far you to fill oat in the event the office of lavedgado a has b coated you reaaniing the appiicauL Plc m be sore b fiII bs the permif/licam mm0 which will bs used m a refeseaee amaI to ad lidos. m applicant that ®at submit mulNpk pandHlieenaa applicadow in my liven yew. need only sabndt am aIDdavd iodiattmg current policy injismsudeag (if necamy) and under "Job Site Adrhesa" the applicant should write "are loeatlaaa in (city or ftwo)." A copy of the affidavit that hen ban officially stamped a marlmd by the city or town may be provided to the aPPliant Y proof that a valid affidavit is on Me for Aft" permits or liegsasm A new affidavit must be filled at each year. Where a home owner at eitim Is obtain; a Ikema or pewit out related to, any business or commercial venture (Le. a dog license or Peewit to burn leaves cue.) said se is NOT required to compkb thin affidavit The Oaks of tnvesdgdkm would Mm he thank ruin advance far year cooperation and should you have any goadow please do ant hesitate to give os a all the oepument'a address, alephow and fax mmnba: The Commonwealth of Massachusetts Department of Industrial Accidents ofllea of farenlptioas 600 Washington Street Boston, MA 02111 Tel. M 617-7274900 ext 406 of 1.877-bfASSAFE Fax M 617-721-7749 Revised 11-22-06 wwvrt»•gov/dia TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRIM•: Job location: Number•—� Sit , Owner of Property: I Dhl AJ nnOF Construction Supervisor. "QLi Vrdt .it Name dress: S FYeit T lyl4s1 v ' Licensed Designee: (If other than Supervisor) Dame 2.15 Responsibility of each license holder. S.O. 4-M ft 0LlTrr CS - d6�3ay 5'� y�i s�xxi License No. Phone No. 4-90 -av71f M 4- CZ&7 3 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, isnot 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: 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 = please indicate the type coverage by checking the appropriate box. A liability Insurance policy -Q Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee daes 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: of Owner or Owner ❑ Agent ❑ Signature: "'Vt!4ZITV V 1 Building Official Approval: TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111 S, I hereby certify that the debris resulting from the proposed work/demolition to be conducted aq 131 'l vPctiyti- Ave . Sa . yt12tHovnf Work Address Is to be disposed of at the following location: /W01ovft1 SOL40 WR—H-r f/tc-t"1171 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. S gnature of Application Permit No. 11 7 S1 3 ate a► TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.1261 (K. PERMIT NO B-14090 _ PROPOSED PERMIT .9 ISSUE DATE :_ 7/1=013 _: USE :: _ _ :::: APPLICANT :Beys'1der9nt`&Table. nc............... JOB WEATHER CARD PERMITTO MlscJtent - — -------- AT (LOCATION) ZONING DISTRICTEE Bldg. Type: lCommercial 10031DUPONTAVE SUBDIVISION MAP LOT BLOCK LOT SIZE BUILDINGISTOBE: CONSTTYPEF--] USE REMARKS erect temporary tent - Big NIcKs Ride for the Fallen - 7/19-7/22113 up AREA (SO FT) EST COST ($131.000.00 PERMIT FEE ($) OWNER OWN OF YARMOUTH /Flax Pond BUILDING DEPT BY ADDRESS 10031 DUPONT AVE South Yarmouth I MA 102W4 CONTRACTOR LICENSE 0 Bayside Tent 6 Table, Inc. 40 C Whites Path South Yarmouth MA 02664 5087604025 PHONE 15087WX815 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Insoector ltmtee uae only flmdt t Fee S Permit expire 6 mouths item isswedale. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUM Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 J (508) 398-2231 Ext. 1(2661 /J i lt,7 k IC CONSTRUCTION ADDRESS: �/ Mg✓r I (/� �f /e`Llil "�,y'"Il7' /'�Z�t%II�IvI���� ASSESSOR'S INFORMATION: Map: 0—b Pucek 1 OWNER:_ �lHr / O^d AtJC,4-, t%✓1 ?4 � ��lyUs�•7N�+.Y'/`,�,� S-0i%lba. NAME PRESENTADDRESS TFI_ # CONTRACTOR: J-�'' 7S;lK ir-4 -! c V�f 'J ��-/ L s �G,o�d/I� t�8 •1Oa, [-�ol� NAME MARING ADDRESS TEL# Residential Commercial 0 Est Cost of Construction S 41 Home Improvement Contractor Lie. 0 Construction Supervisor Lie. # Workman's Compensation Insurance: (check one) I am the homeowner ,^ Al am the sole proprietor 1 have Worker's Compensation Insurance/' ,[ (.� (� Insurance Company Name•. {'s'` cd4 e - Worker's Comp. Policy# f04d ` I t WORK TO BE PERFORMED lrerent (Fire Retardant Certificate attached) 3 0 ✓ / O C WOW Store 9aa / C Siding: # of Square" F 6 C Replacement windows: # —7 / f C Replacement Joan: # ` l/ Re -mot: # of 0 Insulation t ) Stripping old shingles- () going or tayers of existing roof Oki Kings Highway/Historic District RonBng/Siding (Uke for take) -The sNMs will he dhposcd of av t.ocation of Facility I doclareanda penalum of perjur� the stmnens hereto will be jut cause for denial or ion of my )juepe gnd I �( Owsren Signature (err NuchmenO; Appmrnd By: Building Official and correct to the Dent of my k icmie dge and belief. I understand that my false answes(s) a MOL Ch. 269. S ction 1. Date. 7113 Zoning Distrcti Historical District: Yes f Water Resoture Protection District: 1d No Doc. Ilood Plain Zone: Yes Within 100 R. of Wetlands: Yh No Vol The Commonwealth ojMassachusens Deparfinent oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contracton/ElecMcians/Plumbers Applicant Information Please Print Legibly �j Name(Busines/(rgsn;adoo4ndiva4:_ /JGLjS/Gcf -Fo Address:3 tvt�j�t✓t'� �t? Ci /State/Zi : t �/} d�Lb ti Phone #: S��- �,D. L14oL� mployer? Cheek he appropriate boa: ployer with 4. ❑ 1 am a general contractor andIType of Project (required): es (fa and/or part-time).• le Fl=workm' have hired the sub-conttactors listed on the 6. ❑ New construction proprietor or partner- attached sheet 7. ❑ Remodeling have no employees These sub•contracton have 8. ❑ Demolition for me in any capacity. km' comp. insurance employees and have workm'9. camp. insutance.i Buildm ❑ g addition required:) 5. ❑ We are a Corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work myselL [No workers' comp. Officers have exercised their right of exemption per MGL I LO Phunbing repairs or additions insurance required,] f 31L ❑ 1 am a homeowner acting as ■ c. 15Z If (4). and we have no employees. [No workers' I2.❑ Roof repairs 13.0 Other general cOntraetnr (refer to a4) I ;Any eowim t Thal r4tani boa aI mta also att out he m doing g an working thew wottaa' eoatpeoe.tlodPotiry InIft,"Moo. Homtarwan who eebmit din affidavit btdkatlng they w doing all arodt and then him ounide tatrat:tota mat submit a near affidavit indicating such. tCootracmn that chock this box must attached an addibowal ahaa AQwMg the sank of tha tab-meoacton and aw whether o, cam thaw anti have eatplorom If the sub-t arwnota herw eoglwyeew, that' mist provide tbec waste,' coal• walk? tamtba. law an tarptoyer that is providing workers' conrpenmdon bumraasee jar cry tatptoyem Blow h the injorstatlon, r _ Po((r•7'andJobskdr Insurance Company dc Ce Policy a or self-inm tic. a: (� b 5 / Eviration Dater/6 / (4 Job Site Address: City/Statemp: Attach a copy of the workers' compeosatlon policy declaration page (showing the policy member 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 5250.00 a day against the violator. Be advised that a copy of this statemcat may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do herby cerf! j• Arr thepalm end pene/dn efptrJrny that the btjornaddon prmfdd above 1s)rmt e* comrct O,Qictal use o* Do not write In thh area, to he compkard by city or Mtvrs oJJlciaL City or Town: Issuing Authority (circle one): I. Board of health 2. Building Department 6.Other Permlt/Llceuse a 3. Clty/fown perk 4. Electrical Inspector S. Plumbing Inspector Coataet Person: Phone a: ACQ CERTIFICATE OF LIABILITY INSURANCE 1 �7T/i7 1 MCSHEA INSURANCE AGENCY INC 1550 Falmouth Rd Ste #2 Centerville, MA 02632 NSURFD Bayside Tent S Table, Inc. 40C WHITES PATH South Yarmouth , MA 02664 508-888-4956 HYAIFOArm DOES NOT fIUKI Pone-ATlstiea T--U aco i ME! 4` Ace American Insurance Co i I NSUER D: - - - — - THE POLICIES OF NSURANCELISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NATII 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. LTR Ae POIICY NUMBERItopt ExPIRATION IMRS A GENEAAL LIABILITY COMMERCMLGENEMLUAJIM Y tLAMSLLADe ®OCCUR PAv0006132 5/17/2013 5/17/2014 EACH OCCURRENCE f PREMISES EA emAAne f 0 MEO EKPI AIMPMIeII i 0 rEI1soHALaAOVNARIr s 1000000 0000 GENERAL AGGREGATE S. 2000000 GEMLAGGFEGATE LTMT APPLES POLICY �O- LDD PRODUCTS-COMP/OPAOG t 2,000,000 g NROMOBLE LIABILITY ANYAUTO ALLOYAEDAUTOS SCHEDULEDAUTOS HMO AUTOS MON-OW+EDAUTDs 04453770 , 11/30/2012 11/30/22013 COABNEDSINCAELWT f EODILYNXnY ('eP�) f 100 000 / BODILYNAIRY ryAlA ) f 300,000 PROPERTY DAMAGE t 100,000 • GARAGE LIABLlry - AWAUTO AUTOONLY-EAACCIOENT f OTHERTHAN EAAW AUTOONLY. AGO f f EXCE$SNMBRELLA LIABILITY OCCUR �CLALLSWIDE DEDUCTIBLE RETENTION f' EACH OCCURRENCE f AGGREGATE t f f f C w PLOVER OwEILITY Ars EMPLOYmwr& IlTY ANr norRETaiuPAArNUID¢rAlrnf DYfLDaC1BCR OLTAAFDT SPECINIAI PROVISIONS Eder 6824915 5/16/2013 5/16/2014 E.LEACHACCDENT S 100 EL DISEASE -EA EMPLOYE1 f 100,000 EL DISEASE. POLICY LRRT f 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/ EXCLUSIONS ADDED BY ENOONSEMENTISPECML PROVISIONS Town of Yarmouth ACORD25(2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES M CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LABRITY OF ANY KIND UPON THE INSUIIER. ITS AGENTS OR 1298 E 0.0-Tv "OnWWACatw1.w�rt+akiYnntt.c�n yti Fabrk 1'Met+ Ala 30X O END CP-B a�enaor ' CPA;- P.t 1 SIZO WPA• C-t MANUFACTURED Q W CW�apoa CONTROL •,' AWARNING -A { This is a t.emporary•structure,. ' all occtrpant9 should evacuate thi:ferl.irt threa#erring 1 { weatt4f. or ifany conditions occur.;thait"raises doubt � to i the safetyof.this .16 tt . , s t � "� 7Tentltne i FRED'S lw00.99 TIMTS 1•t0699Tents • f�/ltl WbOft3. INC. ww.M.wenu4chnticam d�,�•r „oi Fabric MrM � WBO 30A 0 L-Ci MAQ CP-a R� c�'� « Size Nam:-;ot MANUPACTL;um Dam 1 8 GOUTROL I Q WARNING Q This is a temporary structure, all occupants should evacuate this twit in threatening weatho cw It any conditions occur that raises doubt as to I the satiety of this tent. MC6 N , 50 BROWN LINDQUIST FENUCCIO & RABER ARCHITECTS, INC. 15 November 2010 Mr. James Brandolini, Building Commissioner Yarmouth Town Hall 1146 Route 28 South Yarmouth, MA 02664 RE: Construction Control Progress Report No. 1 New Lodge Building @ Flax Pond Yarmouth, MA Dear Mr. Brandolini: Since the start of construction in early November, we have conducted several site visits to monitor the construction work and adherence to our construction documents for the subject prjea As of this date the following general work has been completed: ➢ Construction staking by the town. D Excavation for footings. D Strip footings with reinforcing bars have been formed and placed. ➢ The grounding connection was made with the rebar prior to pouring. ➢ Foundation walls with reinforcing bars have been formed and placed. ➢ Foundation wall damp -proofing has been installed. The work completed to date by Seaver Construction, Inc., and their subcontractors, has been completed in a good and workmanlike manner, and in general conformance with the drawings & specifications. All required town inspections for work done to date have been completed. Briggs Engineering & Testing have been on site to verify geotechnical soil bearing capacity, visual inspection of rebar placement, and to collect concrete cylinders. Please find attached construction progress photos and the geotechnical report. If you have any questions, Sin" Kurt CC: to contact me at anytime. Jim Lefler (Yarmouth DPW) Bill Caci (Seaver Construction) Dennis Mason (Seaver Construction) Rick Fenuccio (BLF&R Architects) Tim Sawyer (BLF&R Architects) 200 WILLOW STREET. SINE PH 508.862.8382 VMMOUMPORL MA M675 W W W.CAPEARCHITECTS.COM FAX 505,W-2828 No `_ t, ✓ w .,� ♦�rY �ai �y y11 11 l / 1 w.x �. /_v. Sr� 3r �G '.Sir r.:�4r ry e YC _ � I✓ !Y �� ��!W� 3< iY 1 �•flu N� .. _ • ' .. ♦A 1'F' ... R'E Jiv .., +•WI•J .. w � �_1� 1 � ems. _ �6�-ill ,� .. .ati �,.,. -�- .� �� _4 "�� .• .. ��"••7�7� '•� �., • � 'any . -- � j . � � . _ . - •. �.l � �_... F r AW ✓ter' - � s'.�j ►..., r�'•, `+, wt 11/15/2�1 ♦FUM _ .. _.. _ _ - .. �. .... ♦ I ♦ ' �I ` 1 ti•✓lY'h„'d4v M. �+....�..y 1W . _ .. � �.. ' � �•ia \� �F •tom. �\�Y\�—� •- =` — L ��.CQSP+rAf. • r Yy L t Yam\ � • 1 Y' ♦ Y \ a� � (\ O "mot /� :� .•.f� a •�L w _ � 11 I o '. • r .... � „�,. L{ r :.` i1.: ir- �? L '. tad'' i � a L J � 1 • a kV: •• ✓ t _ _ .11 ....�+.-+LiY:. a�iT.,•�rrry4ir�r.. L�.La— • k.. [�:'.: �..•` :rw�Li �•.�_. ...: _ `f�: ... _ a t< _..1 L �a.L�� .._ r V"+'•'!,—'�M11•M'. 1"+"'�r ^fin'+---•• ,-v y 7 ny"; +..^.....r r a•� 1ayy +/r i.:.. .. e J 6 ': '" �Y:e, �` �.� .r.I`t iw�T'*'1�•ti'N 'S _.fY .!".: JY P +�+r.' � ♦. �. a /' ~ .., { lbw gal}. x. .f. i`f FILE COPY SEEN BROWN LINDQUIST FENUCCIO & RABER ARCHITECTS, INC. IS November 2010 Mr. James Brandolini, Building Commissioner Yarmouth Town Hall 1146 Route 28 South Yarmouth, MA 02664 RE: Construction Control Progress Report No. 1 New Lodge Building @ Flax Pond Yarmouth, MA Dear Mr. Brandolini: 5 �-3 IUo • IUIQ' v� Since the start of construction in early November, we have conducted several site visits to monitor the construction work and adherence to our construction documents for the subject project. As of this date the following general work has been completed: D Construction staking by the town. D Excavation for footings. D Strip footings with reinforcing bars have been formed and placed. D The grounding connection was made with the rebar prior to pouring. D Foundation walls with reinforcing bars have been formed and placed. D Foundation wall damp -proofing has been installed. The work completed to date by Seaver Construction, Inc„ and their subcontractors, has been completed in a good and workmanlike manner, and in general conformance with the drawings & specifications. All required town inspections for work done to date have been completed. Briggs Engineering & Testing have been on site to verify geotechnical soil bearing capacity, visual inspection of rebar placement, and to collect concrete cylinders. Please find attached construction progress photos and the geotechnical report. If you have any questions, Since Kurt CC: Jim Lefter (Yarmouth DPW) Bill Caci (Seaver Construction) Dennis Mason (Seaver Construction) Rick Fenuccio (BLF&R Architects) Tim Sawyer (BLF&R Architects) 203 WILLOW STREET. SUITE YARMOUTHPORL MA=75 contact me at anytime. WW W.CAPEARCHITECTS.COM PH 508-362.8382 FAX 508-362-2828 r �•,s r t S ii� �' _ ii- r ria w � y�y f �4uG a9. 1 f1012010 02 34 si y a i. +4 - 'mot �� +,� _� _ •. y �� µ � ^•a .y{ 1� i OL#gi- i'' �l �AP-`i ��'.� 9. _.R '•� Y!Z �' `Y I•' :iISG ram' It' _ "--.+w Z�,Ov_ R '••-_. tlp — .T 92 kv- s /ataIV\ HRI0©9Brigs Engineering h Testing n Orviv�s nr FCAmcurs lxc W Brown, Lindquist, Fenuccio & Raber Architects, Inc. November 5, 2010 c/o Tim Sawyer Project No. 25501 203 Willow Street, Suite A Yarmouthport, MA 02675 RE: Geotechnical Borings and Report For Proposed Building at Flax Pond At 383 North Main Street, Yarmouth, MA 1.0 Project Description and Surface Conditions In accordance with your authorization on November4, 2010 of our Proposal No. MA. 02.992.0, Briggs Engineering & Testing, A Division of PKAssociates (Briggs) has completed our investigation of the subsurface conditions at the above referenced location and prepared this Geotechnical Report. The project site is located in the Yarmouth on the west side of North Main Street, between Melville Road and Great Western Road. A private road extends west from North Main Street into town property. Municipal facilities including wells are located on both sides of the private road. A camp is located at the west end of the road and overlooks a pond located downhill, west of about 5 wood framed camp buildings. Topography at the site is relatively level but slopes down moderately to steeply to the pond. The top of slope is located about 200 feet west of the proposed building. Topography within one mile of the site Is undulating with mostly gentle to moderate slopes. The proposed construction is a one story wood framed structure with concrete slab on grade. An assumed allowable bearing pressure of 1.5 tons per square foot is Indicated on the project plans. The primary purpose of this Investigation is to evaluate allowable bearing pressure, seismic site class and liquefaction potential. The proposed building layout and immediately surrounding site features are shown on the attached Figure 1. Test borings were conducted to evaluate soil and groundwater conditions at or near the proposed building location. The subsurface conditions revealed via these explorations are discussed in this report as follows. Z.0 Subsurface Explorations The subsurface conditions at the Site were explored during this investigation under the supervision of the undersigned Briggs' Geotechnical Engineer. The explorations consisted of advancing two (2) test borings just outside the proposed building footprint Refer to Figure 1 for exploration locations. Proposed Building at 383 North Main Street. Yarmouth, MA Briggs Project No. 25501 November 5.2010 Page 2 of Desmond Drilling of Orleans, MA performed the borings on November 5, 2010 by. The borings were advanced using a truck mounted drill rig. Borings were advanced in accordance with ASTM D1586, "Penetration Test and Split Barrel Sampling of Soils". Standard Penetration Tests (SPT) were performed continuously. Borings were advanced using hollow stem augers and water head was maintained by injecting water through the augers prior to removing drill plug and/or sampler in order to reduce or eliminate blow-in of the sandy soils. Soil samples were field classified by David Getsser, Geotechnical Engineer on a full- time basis using the Bemmister Soil Classification System. Soil descriptions by Briggs are presented in the attached test boring logs. Soil samples from all borings were retained by Briggs after completion of the test borings. 3.0 Subsurface Condidons Soils stratigraphy consists of topsoil over subsoil underlain by silty sands and sands over sandy sitt These soil strata are discussed further below. Topsoil - Surface topsoil was observed in the side of the existing building excavation to a depth of approximately 6 inches. This layer was not sampled as it has been removed from the proposed building area. Subsoil - Subsoil was observed in the side of the existing building excavation, beneath the topsoil to a depth of approximately 1.5 feet or less. The subsoil is a silty sand with little (10 to 20%) non plastic fines (sift) and less than 1% organic content based on visual and textural examination by Briggs. This layer was also not sampled as It has been partially removed from the proposed building area. Sand - Undisturbed sands were encountered from depths of 4 feet to 40.5 feet In B-1 and about 35 feet below existing grade in B-2. The sand Is mostly fine to medium with no gravel encountered and trace to tittle silt content The sand is mostly light brown with brown to orange brown zones. SPIT N-Valuesi ranged from 4 to 12 in the sands. This Indicates loose to medium dense relative density. Sandy Silts - Undisturbed Sandy Silts were encountered in both borings below depths of 40.5 and about 35 feet in B-1 and B-2, respectively. The sandy allots are mostly non - plastic fines with little to some (10 to 35%) fine to medium sands. The sandy sifts are mostly grey broom to brown with stratified layers of orange -brown to brown silty sands. N-Values were 22 and 321n the two samples recorded with the required 16-inch penetration. This Indicates medium dense to dense relative density. Borings terminated in the sandy silts at depths of 41 and 46 feet Refusals were not encountered in the borings. Hand written test boring logs are attached to this report Typed logs will not be prepared. 1 SPT N-Value Is the number of blows for a 140 lb. hammer failing freely through 30Inches, required to advance the standard split spoon sampler the last 12 Inches of an 18 inch sampling interval. Proposed Building at 393 North Main Street, Yarmouth. MA Briggs Project No. 25501 Ndvember 5, 2010 Page 3 of 7 3.1 Groundwater Upon completion of each test boring and at later times up to 20 minutes later, a tape measure with hollow'plunker device was lowered into the bore -hole to measure water that might have seeped into the borehole during penetration of the boring and/or after removal of sampling equipment Groundwater was encountered in the boreholes at depths of 24 feet at B-1 and 23 feet at B-2. Boreholes collapsed within 30 minutes of removing augers and subsequent groundwater readings could not be measured. The measured water depths are consistent with the moisture contents observed in the test boring samples and are likely within a couple of feet of actual stabilized groundwater depth at the time of the investigation. Groundwater levels may be affected by local anomalous conditions such as underground utilities or confining silty or clayey soils as well as seasonal factors and thus may not represent the level to be encountered in the future. Generally, groundwater levels are highest in the spring and lowest in the late fall. Since the water levels were measured during the late mid autumn, groundwater levels may be about average and lower than springtime water depths. For design purposes, Briggs assumed high groundwater depth at 16 feet depth to calculate geotechnicai parameters in Section 4 of this report 4.0 FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS 4.1 Foundation Design We recommend that the proposed building be supported on a conventional shallow foundation consisting of continuous wall and spread footings. We recommend that the footings bear directly on the inorganic, undisturbed, sands or compacted Structural Fill or Crushed Stone placed over the above stated undisturbed sandy deposits. Footings should be sized for an allowable bearing capacity of 1.3 tons per square foot (tso. This Is equivalent to 2600 pounds per square foot (pso. The allowable bearing capacity is for all combinations of live and dead loads with a 33 percent increase allowed for seismic and wind loadings. Strip footings should be at least 24 Inches wide and isolated column footings should be a minimum of 36 inches. The bottom of all exterior wall or column footings should be a minimum of 4.0 feet below finished grade to provide adequate protection against frost heave action. The excavation to the undisturbed subgrade has been observed by the undersigned Geotechnical Engineer and is consistent with the bearing subgrade Identified above. Should over -excavation below footing elevations be required to reach the undisturbed sandy subgrade, the excavation width must be widened to include the foundation stress zones. Refer to Sections 4.3 and 4.5 for details regarding excavation and backfilling in foundation stress zone areas. Proposed Building at 383 North Main Street. Yarmouth, MA Briggs Project No. 25301 November 5, 2010 Page 4 of 7 Total settlement due to the compression of the bearing soils should be less than 1 Inch and the total differential settlement should be less than 1/2 Inch and should pose no significant structural problems. Hydrostatic uplift is not a design concern as proposed slabs are well above groundwater and existing site grades. 4.1.1 Slabs It is our understanding that an 8 Inch thick lift of gravel borrow fill is specified under the proposed slabs.Briggs has collected one sample of the site sand from the east wall footing excavation. This fill has less subsoil and Is slightly less silty. At your request, Briggs can provide recommendations for blending this material with crushed stone to meet the specified gradation. Otherwise the sample is on hold, pending a directive by the client 4.2 Seismic Design The undisturbed sandy subgrade and compacted Structural Fill or Crushed Stone are not susceptible to liquefaction during the postulated seismic event given their gradation, depth to groundwater and relative densities. This evaluation is in accordance with the Massachusetts State Building Code, Seventh Edition. Tabulated spectral response acceleration coefficients, S. and St are listed as 0.19 and 0.052 for projects in Yarmouth per Table 1604.10 of the Code. Site soils and rock are Seismic Site Class E for the proposed building location. 4.3 Excavations The proposed footing areas, plus an additional 2 feet all around should be excavated to the undisturbed, Inorganic, sandy bearing strata. The surface topsoil and subsoil must be removed. Deeper over -excavation may be required if loose soils, fills or organic soils are encountered deeper. This condition was not encountered In the borings or open footing excavations and Is not expected. Topsoil has been removed from the building area. Minimlal depth of subsoil exists in the proposed slab area and should be removed to inorganic sands. Excavated sands and subsoil have been piled outside the building footprint Two piles along the east side of the building appear to be sands with about 10 to 15% fines. Two piles on the southwest and west sides are similar but have about 10 to 20% fines and more subsoil content. The two easterly piles appear usable as Granular Fill. This material could also be blended with aggregate fill such as % or 1.5 inch crushed stone to create Structural Fill. Refer to Granular Fill and Structural Fill gradation specifications and additional discussions in Section 4.5. Groundwater was encountered below a depth of 20 feet Dewatering of excavations will not likely be necessary. However, dewatering might be necessary after heavy rainfall. Water control recommendations are presented in Section 4.4. Excavation to the subgrade should not be accomplished during heavy rains. Proposed Building at 383 North Main Street, Yarmouth, MA Briggs Project No. 25501 November S, 2010 Page 5 of 7 4.4 Water Control Groundwater will not likely be a major concern for this project. If groundwater is encountered after rain -fall, then limited pumping may be necessary. Crushed Stone wrapped In filter fabric should be used to protect the subgrade if the subgrade becomes wet This will allow future dewatering by sump pumping should water levels rise in the crushed stone. This condition is not expected. Otherwise no backfill on the subgrade appears warranted. The subgrade has been rained on and is not presently disturbed by the recent rainfall Gradation recommendations for Crushed Stone and Structural Fill are presented In Section 4.5. The crushed stone layer requires compaction by making at least 4 passes by a vibratory plate compactor or vibratory roller. Also, surface drainage should be directed away from excavations during construction so that the bearing surfaces do not become softened by water flow or puddling. Rapid water movement can also scour soils and undermine foundations, therefore surface water protection such as earth berms should be constructed. This can be accomplished with proper grading or construction of small dikes at the edge of the excavation. AS Bacldlll and Compaction Excavated sands and silty sands may be segregated for possible reuse as Granular Fill or blended with aggregate materials to create Structural Fill as discussed in Section 4.3. Offsite borrow materials should meet the Structural Fill gradation except under non- structural areas such as landscape areas. The Granular Fill can be used inside the building and against the interior side of foundation walls and under pavements and walkways at depths greater than eight Inches below the base of slabs and pavements. Granular Fill is not suitable under footing stress zones or within three feet laterally outside the foundation walls. Exterior fill within 3 feet of the exterior walls and the final eight inches of fill under slabs and pavements should be Structural Fill. Barkfilling and compaction must be accomplished 'in the dry'. Where water is encountered the water should be pumped while excavating and removing all muddy soils. The resulting subgrade should be covered by at least 4 inches of crushed stone on filter fabric and compacted. Subsequent backfilling may require pumping as the compaction will likely draw water that can often result in instability and fill moisture that will prevent effective compaction. Within the areas excavated for footings, walls, and other limited areas where large compaction equipment cannot work, we recommend that the fill be placed in loose lifts no more than six inches in thickness and be compacted with small hand manipulated machines such as pneumatic compactors, vibratory compactors, eta In areas where large vibratory compactors such as a Raygo 400A or equivalent can be used, we recommend that the loose lift thickness not exceed 12 Inches. Proposed Building at 383 North Main Street. YarraouN, MA Briggs Project No.25501 November 5, 2010 Page 6 of 7 All back ill placed in load bearing areas including under slabs and under footings should be compacted to a minimum of 95% of the maximum dry density as determined by the test designated ASTM D1557. Structural Fill should consist of well graded natural sands and gravel free and/or crushed concrete, from excessive plastic fines, organic matter and deleterious material, and should have the following gradation: RECOMMENDED STRUCTURAL FILL GRADATION Percent Passing U.S. Sieve Size & Number Maximum Minimum 2/3 lift thickness 100 100 1 inch 100 60 No.4 85 25 No. 20 60 10 No.50 35 4 No.200 B. 0 ' 0 to 6% for backfill within 3 feet laterally behind earth retaining walls. Granular Fill should consist of well graded natural sands and gravel and/or crushed concrete, free from excessive plastic fines, organic matter and deleterious material, and should have the following gradation: U.S. Sieve Size & Number 213 lift thickness 1 inch No. 4 No. 200 GRANULAR FILL GRADATION Percent Passing Maximum Minimum 100 100 100 60 90 25 15 0 Crushed stone should have the following gradation: CRUSHED STONE Percent Passing U.S. Sieve Size & Number Maximum Minimum 1Inch — 100 314 inch 100 90 1/2 inch 50 10 3/8 inch 20 0 No.4 5 0 5.0 Limitations and Exclusions All the professional opinions presented in this report are based solely on the scope of work conducted and sources referred to in our report. The data presented by Briggs In Proposed Building at 383 North Main Street, Yarmouth, MA Briggs Project No. 25501 November5.2010 Page 7 of 7 this report were collected and analyzed using generally accepted industry methods and practices at the time the report was generated. This report represents the conditions, locations, and materials that were observed at the time the field -work was conducted. No inferences regarding other conditions, locations, or materials, at a later or earlier time may be made based on the contents of the report No other warranty, express or implied is made. This report was prepared for the sole use of our client. The use of this report by anyone other than our client or Briggs is strictly prohibited without the express prior written consent of Briggs. Portions of the report may not be used independently of the entire report The above recommendations and conclusions are based on our evaluation of the obtained data presented In the text We would welcome the opportunity to monitor the pertinent phases of the foundation construction; thus, if differences are found between the field conditions described herein and those encountered during construction, we can modify our recommendations in a timely and professional manner. Thank you for engaging our services to undertake this project If you have any questions, please do not hesitate to contact us at your convenience. Very truly yours, Briggs Engineering & Testing �lN David W. Geisser Project Engineer DWG:NAL:dg Enclosures Figure 1—Site Sketch Test Boring Logs Nicholas A. Lanney, P.E. Professional Engineer /J EXISTING BATHROOMS BUILDING O EXISTING HYDRANT .� PROPOSED UO.DING B-17 FOOTING EXCAVATE 4 TO 4.5 FEET BELOW EXT UUOR GRADES INTO UNDIS IMED SANDS AND SILTY ANDS. TO POND 8-2 TO NORTH MAN STREETN• 72/a7v` LEGEND, EXPLORATION LOCATION PLAN PRN U�GY AT F PHO, D6is10 G S Number and approx. location RTH O •-�— B-z of test boring Scale: N.TS. Drawn: DWG FIG 1 Date:11 15 / 10 Check: PMS Briggs Engineering & Testing A Unsmn ofPKAn Wm Nm Cape Cod Test Boring 511ayberRoad,odaamMA02653 (508) 240.1000 div. Desma d Well Driffliv. khc f) Project MAX �onr�.-�QIrkOV Main S'r' . -- -'-" Boring 140. — Sheet 1 of 1 Drsler Patrjtic Desmond Helper. William Uquhsrt inspector. Dave Getsse r Boring location r Yod RA o,)-f r}r m Ground Surface Elevation: Data start 10152010 Date end 10/8Q010 Sampler consists of a two Inch spit spoon driven using a 140 tb. hammer falling thirty Inches Note% IScreen JAuger Size: 61W x 4- RSA Casing Size: WA Si e. WA •. ' Depth Sample Semple Description. . Fn NO PEN/REC DEPTWFT BLOWS 6- ' _2 .4 -10 - -11-12 -13 -14 -16 -17 ;20 -21 _22 -23- -24 mW s�c� T.L�Ml/rCcC ib �i 7111[��� 'S f/n��IiJ /.ten ✓ 411, R_ L D t! c - S<.N c�-'- �7 liT.ce r}a /fete �.�-^•. 1 Z't - / u S Y o Y� �- 7 -25 -27 -28 -29 30 •31 32 33 -34 8 ! ro.28 �v > 1 v � Sa- ol, vt9.M r wt ErAt ' R� b e Ye - End of aempta: Groundwater encountered: ci 4 2- 0- .+s+*r. ` ` - .1.. Granular soils BLOWSIFT DENSITY Cohesive Sans BLOWS/FT DENSTY Proportions Used well Installation Key _CONCRETE N• _SANDPACK l _SAND ACKFILL ®-BENTONKF ITE It -SCREEN -APPROX WATER • 0-4 V.LOOSE 4-10 LOOSE 10-30' l6iDENSE 30.50 DENSE > 50 V. DENSE >2 V.SOFT 2-4 SOFT 4-8 M.STIFF 8-15 STIFF 15-30 V. STIFF > 30 „�D Trace 0-10% Little 10'-20% Same20_35% And 35-50% CAPE COD TEST BORING BORING NO. 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ComCheck Compliance Certificates Proposed Lodge Building @ Flax Pond Recreation Area CC: G. Allaire (DPW) — Memo Only via e-mail Peter Johnson -Staub (Asst. Town Administrator) — Memo Only via e-mail P. Armstrong (Recreation) — Memo Only via e-mail J. Kissida (CDM) — Memo Only via e-mail T. Sawyer (BLFR Architects) — Memo Only via e-mail Jim: Per your request and as agreed during our most recent telephone conversation, I am submitting a set of final construction bid documents for your review of the subject project. I am also submitting the following Com-Check Compliance Certificates to show envelopes and systems compliance with the newly adopted 2009 IECC (Energy) Code, prepared by our office and our Consulting Mechanical and Electrical Engineers: 1. Envelope Compliance Certificate 2. Mechanical Compliance Certificate 3. Interior Lighting Compliance Certificate 4. Exterior Lighting Compliance Certificate Please note that the mechanical certificate does not conclude with a "pass/fail" statement, but rather has a series of inputs for various equipment to show compliance with the energy code. Attached to this certificate is an e-mail from our HVAC Design Engineer addressing this item. Additionally, there does not appear to be a directly applicable building type in the software so we are using "Library / Office" as the most comparable "Assembly" type building. The project is going out to bid this Wednesday so please contact me at your earliest convenience if you have any questions or comments and, if necessary, we will address them through a bid addendum. Thank u for your continued assistance. Rick u cto C. 203 WILLOW STREET, SUITE PH 508-362-8382 VARMOUTHPORL MA 02675 W W W . C A P E AR CH ITE CTS. COM FAX 508-=-2828 COMcheck Software Version 3.8.0 Envelope Compliance Certificate 2009 IECC Section 1: Project Information Project Type: New Construction Project Title: LODGE BUILDING @ FLAX POND RECREATION AREA Construction Site: Owner/Agent Designer/Contractor. FLAX POND TOWN OF YARMOUTH TIM SAWYER YARMOUTH. MA 02664 1146 ROUTE 28 BUR ARCHITECTS SOUTH YARMOUTH. MA 02664 203 WILLOW STREET 508398-2231 SURE A YARMOUTHPORT, MA 02675 508362-8382 TIM@CAPEARCHRECTS.COM Section 2: General Information Building Location (far weather data): Yarmouth, Massachusetts Climate Zane: sa Vertical Glazing / Wall Area PoL- 15% Skylight Glazing / Roof Area Poi.: 1% Adhft Tvtre(s) Library Floor Area 1614 Office 2014 Section 3: Requirements Checklist ,. Climate -Specific Requirements: component NamreMescrlption Gross Cavity Cord_ Proposed Budget Area or R Value R Value Ufactor Ufactorly Perimeter Floor 1: Slab-OrWradwUnheated, Horimntal with vertical 4 R 279 — 10.0 . — — 6derior Wall 1: Wood -Framed. 16' o.c. 2640 21.0 0.0 0.062 0.064 Window 1: Wood Frame:Double Pane with Low4E, Clear, SHGC 280 — — 0.300 0.350 0.32 Dow 1: Glass (> 50% glazing):Metal Frame, Entrance Door, SHGC 105 — — 0.700 0.800 0.42 Roof 1: Insulation Entirely Above Deck 1614 — 38.0 0.026 0.048 Skylight 1: Metal Frame:Double Pane with Low-E, pear, SHGC 45 — — 0A30 0.600 0.42 Roof 2: Attie Rear with Wood Joists 2014 38.0 0.0 0.027 0.027 (a) Budget U41actors are used for software bas srme calculations ONLY, and are not code requirements Air Leakage, Component Certification, and Vapor Retarder Requirements: (] 1. AS joints and penetrations are caulked. gasketed or covered with a moisture vapor -permeable wrapping material installed In accordance with the manufacturer's Installation Instnxilons. 2. Windows, doors, and skylights cerdfled as meeting leakage requirements I] 3. Component R-values & U-facfors labeled as certified. (3 4. No roof Insulation Is Installed on a suspended ceTmg with removable ceiling panels Project Title: LODGE BUILDING @ FLAX POND RECREATION AREA Data filename: H:LCument PrgectsWuniepWWW Pond- Lodge Big. 201OWLAX POND.cck Report date: 08113/10 Page 1 of 2 J p S. NNW components have supporting eonanenraam for proposed ufactom US kwMan Installed snmrding to manufacturers kWnx:bons, in substantial contact with the surface being Inisnated, and in ■ manner met addevas the rated R-value wltt e d compressing the kamdatkn. 07. Blair. elevator drag vents, and other outdoor air intake end mAaust openings In the building envelope are agrdpped with mdortred dar pera. O a. Cargo doors and loading dock doors are weather sealed. 9. Recessed lghtkV azhees Installed In the bulding envelope are Type IC rated as meeting ASTM E293. are sealed with gasket or caulk. 0 1QBuldng endran on doors haw a vesbl*M equipped with closing devices. aceptiorw p Building entrances with reviving doors. p Dogs thet open dlecny non ■ space less than 3000 sq. fL in was. Section 4: Compliance Statement Cornpflance Warrant The proposed envelope design represented In this dacvmerd Is consistent with the hiding pans, specifications and other kalailelonns adrMted with thle pond application. The Ixaposed envelope system has been designed to reel the 20091ECC rewirements In COlAdreck Version 3.&0 and to comply with <he mandatory tequ en h the Requl CheddIsL 00 ��Mrtio, �Eti� uscF+v 8 /6 ZQ/0 dame -Tile signal" Data Rojed Tkkr LODGE BUILDING ® FLAX POND RECREATION AREA Report date: 08/13/10 Data filename: N:LCunenl ProjedsWunk1paWlax Pond- Lodge Big- 2010WLAX POND.cdk Page 2 of 2 6 COM check Software Version 3.7.1 *'(1 Interior Lighting Compliance Certificate 2009 IECC Section 1: Project Information Project Type: New Construction Project Title : New Lodge Building at Flax Pond Construction Site: Owner/Agent Designer/Contractor: Flex Pond ReaeaNarel Area Town of Yarmouth, MA Steven Benhalette, LC Town of Yarmouth YxmoutlL MA Building Engineering Rears Inc Yam outk MA 28 Main Street BuNng 3A North Easton. MA 02356 W&230-0260 SBenheleaeGBER-Engineertp.Com Section 2: General Information Surding the Description by. Activity Type AdMIX iltr" Moor Area Okdng: Forn ly g Section 3: Requirements Checklist Interior Lighting: 0 1. Total proposed wafts must be less than or pual to low allowed watts. Allowed Watts Proposed Watts Compiles 5168 3813 YES Controls, Switching, and Wiring: [12. Daylight auras Under skylights more than 15 teat from the perimeter two fighting conhtrols separate from daylight zones adjacent to verdcalfenestration. - -- 0 3. Daylight zones have Individual fighOV controls independent from that of the general area lighting. Ercapdorrs. Contiguous dayagtt zones sphaning no more than two orientations are allowed b be controlled by a single controlling device. Daylight spaces enclosed by wells or caring height partitions and contelNng two or fewer light fixtures are not required to have a separate switch for general area lighting. (34. Independent controls for each space (switrh/ocauxency sensor} its: Areas designated as security or emergency areas that must be continuously illuminated. Lighting In stairways or corridors that are elements of the means of egress. 0 5. Master switch at entry to hotellmotal guest room. (36. Individual dwermg Units separately metered. 0 7. Medical task lighting or oruhistory display lighting claimed to be exempt from compliance has a control device Independent of the control of the nonexempt rgheng. 08. Each space provided with a manual control b provide uniform light reduction by at least SOX. Only one kaninahe In apace: An omhpent-sensing device controls the area: The area Is a corridor, storeroom, tesboan, public lobby or sleeping unit. Project Title New Lodge Building at Flax Pad Data filename: P:11011I90rrwingMEledElecbicol COMCha&cck Report data: 08M0f10 Page 1 of 5 Areas Aral use Was Area 02 Watlstsq.fL O 9. Autornelc igh&q stwloR oonh In buUdkw larger lm 5.000 sq.fL &w@Pecrw Slesping unls, patent cars areas: and spaces where automatic adutoff wotdd endanger safety or semalty. p t0.Phobmllastrarnnkml&newatchonexteriorIghtL Ltgwg Mended for 24 has use. 0 I I.Tandem wired ons4wW and Reaedar p Wasted kar*Wm (No skVW4emp balasts). . Electronic Mgh-hequancy balasts: LurnbuOres an emcpersy drmb or with no available pair. Section 4: Compliance Statement Cwrplance Statemwe The proposed Ightbg design represented In this dcasnent Is =wdstsnt w0h the brdlding plans, spedricetlms wrd other cdadado s adanMed wM ads pwffd eMkaUwr. The W &g system has been designed to mot dw 2009 IECC requharrm In COMdyglr Vwsion 3.7A end Iocpr" wOh fre and ukeptwds in the Regriemwrb Cheditt 3 MA ID Pro)ed Tib: New Lodge WkIng at Flax Pond Report dale: 08MGM0 Dale Maranon: M100390rawhgslOWEbdriced COMChedccdc Page 2 of 5 eCOMcheck Software Version 3.7.1 �J(l Interior Lighting Application Worksheet 20091ECC Section 1: Allowed Lighting Power Calculation A 8 C D Area Category Floor Area Allowed Allowed Watt (ft2) Watt 1112 (B x C) DWng: Family 3230 1.6 5168 Total Mowed Watts 5168 Section 2: Proposed Lighting Power Calculation A 8 C D E Fhttt m to: DescAptlon I Lamp I Waage Per Lamp I Ballast Lamps/ $ of F stun (C z D) Fbdms Fbdms Walt Multlpurposs Lodge Bldg (DWng: Family 3230 sq fL) Lbtear FMmreacent 1: A W-ClnfinG well mowrt lixt r I46' T5 HO 54W 1 Electraric 4 8 242 1452 Lkww FMarescmd 2. Al: C-0' btrnred wall mount 146' T5 HO 54W I EledroNc 2 6 121 726 Linear FMxxaseeM I At 4'-0' Indlmd Wall Mourd 146' T5 25W I Eledrorde 1 2 33 66 Limper Flxxescend 4: B. 2x4 Direct Indirect 145' T5 28W I F7ec6onic 2 a 88 528 Linear FWmscent 5: B1: 2x2 Died indirect 122' T514W I Electronic 2 1 34 34 Urrear FWaescerd 6: C. Cl: 2x4 boffer 146' TS 25W I Eledratia 3 6 99 594 Unear FMmrescerr T. D: Suface wraparound I Or T5 29W I Elecbwk 2 6 66 396 Linear Fkxwescent 8: G: Lhdercabinet I2r T514W I Becbortic 1 1 17 17 Total Proposed Watt a 3513 Section 3: Compliance Calculation a Ow Total Allowed Wa>t mban 6m Total Proposed Wags is greater 8>en or equal to zero. 6te buidFg complies. Total Allowed Wafts a 5168 Total Proposed Walt a 3813 Project Complance a 1355 Project Title: New Lodge Su" at Flu Pond Data lVenane: P.1100391Drawtgs%EWE1ect ical COMChKkccM Report date: 08/10110 Page 3 of 5 COMcheck Software Version 3.7.1 Exterior Lighting Compliance Certificate 2009 IECC Section 1: Project Information Project Type: New Construction Project Title : New Lodge Building at Flax Pond Exterior Lighting Zone: 1 (Developed rural area) Construction Site: Owner/Agent Flax Pond Recreational Area Town of Yarmouth, MA Town of Yarmouth Yarmouth. MA Yarmouth, MA Designer/Contractor: Steven Berthelette, LC Building Engineering Resources. Inc. 26 Main Street Building 3A North Easton. MA 02356 508.230-0260 SBeMeleOe@BER-Ergtrreering.Can Section 2: Exterior Lighting Area/Surface Power Calculation A B C 0 E F ExteriorAreatSurface Quantity Allowed Tradable Allowed Proposed Watts Wattage Watts Watts / Unit (C X D) Main entry 6 R of door width 20 Yes 120 72 Otherdoor (not main entry) 6 R of door width 20 Yes 120 108 Other door (not mein entry) 3 R of door width 20 Yes 60 36 Total Tradable Wetbra 300 216 Total Allowed Waft - 300 Total Allowed Supplemental Waft— - 500 • Wattage tradeoffs are any allowed between tradable eraeshiudaces. A supplemental allowance equal to SW watts may be applied toward compliance of both non -tradable and tradable areas/surfaces. Section 3: Exterior Lighting Fixture Schedule A B C D E Fixture ID : Description I tamp I Wattage Par Lamp I Ballast Lamps/ a of Fixture (C X D) Fixture Fixtures WatL Main entry (6 R of door width): Tradable Wattage Compact Fluorescent 1: Et: Recessed vandal Resistant I Triple 4-pin 32W I Electronic 1 2 36 72 Other door (not main entry) (6 R of doorwldthj: Tradable Wattage Compact Fkcrescent 2: It SoIBt Vandal resistant foam I Triple 4-pin 32W I 1 3 36 108 Electronic Other door (no main entry) (3 R of door width): Tradable Wattage Compact Fluorescent 3: E., Wet vandal resistant fixture I Triple 4-on 32W I Electmk: 1 1 36 36 Total Tradable Proposed Watts 216 Section 4: Requirements Checklist Ughting Wattage: iJ 1. WithM each non• radable arealsurface, total proposed watts must be less than or equal to total &towed watts. Across at tradable areaslsurracm, total proposed wafts must be less than or equal to total allowed watts. Compliance: Passes. Controls, Switching, and Wiring: Project Title: New lodge Building at Flax Pond Report date: 08110110 Data filename: P,%100391DrawingstElac%El&cbiral COMChedLcdr Page 4 of 5 l7 2. Al exemption claims are associated with Mures that have a control device independent of Ne control of the nonexempt lighting. p 3. Lighting not designated for dusk-krdawn operation Is consoled by either a e phobsenaw (vWN Urns s"chl or an astronomical time switch O 4. Lighting designated for dusk-lo-dam operation is controlled by an astronomical lone switch or ptwtasansor. 5. AS lone switches are capable or retekdrg programming and the time setting during loss or power for a period of at least 10 hours. Exterior Lighting Etfitary: O 6. Al Manor bukri g growls lur inakes that operate at greater Nan 100W have ndrimum afficaW of 60 irnenhNaLL Excepf w controlled by notion sensor or exempt ken consideration under the provisions of Section 505.6.2. �![fefjS):J.fgh6n{i'$A9SE9.D63fpriZ?°%li�itlfe`(icd'de.avl.-:::aft. �. .. Section 5: Compliance Statement compliance Stadement The Proposed sxtaricr lighting design rel and other calculations submitted with this pemA applicatWrL The 7eeekensents in CCMu wck Version 3.7.1 and to cornaly wN the In this document is ccx Istent wN the building plans. specifications lighting rtitem has been designed to one the 2009 IECC In the Requirements Checklist. Date Project Title: New Lodge Building at Flat Pond Data fibenerne: P110039%DrawingsM3eclEkddual COMChadLcck Report date: 06f1gn0 Page 5 of 5 Tim Sawyer From: Michael Gagner [mgagner@ber-engineering.com] Sent Friday, August 13, 2010 8:58 AM To: Tim Sawyer Subject RE Flax Pond Tim, I do not think it tells you directly that you pass. You input the info for the specific systems and then It allows you to print out the sheets. For the heat pumps, R is looking for seer and hspf. These have to be over a specific number depending on the code. The program will not allow me to put in numbers lower than that. So I think that Is how it tells you that you pass. Thanks Michael Gagner Mechanical mga nmRBER-Engineering corn BJEJR . BUILDING ENGINEERING RESOURCES, INC. 28 Main Street, Building 3A 1240 Pawtucket Avenue North Easton, MA 02356 East Providence, RI 02916 T 508230.0260 T 401.435.4602 F 508230.0265 F 40I A35A608 DESIGN I KNOWLEDGE I SOLUTIONS Celebrating 15 Years of Exceptional Service in MEP/FP Engineering From: Tin Sawyer [mallto:Tim@capearchtects.com] Sent: Friday, August 13, 2010 8:52 AM To: Michael Gagner Subject: RE: Flax Pond 1 am not as familiar with the mechanical comcheck as the envelope compliance. Does it tell you if it passes its not obvious to me. Tim Sawyer Brown Lindquist Fenucclo & Raber Architects Inc. 203 WMow Street Suite A Yarmouthport, MA 02675 www.caoearcNtects.com Tel: 508.362.8382 e:d 17 Fahc 608.362.2828 From: Michael Gagner[mailto:mgagner0ber-engineering.com] Sent Friday, August 13, 2010 8:45 AM To: Tim Sawyer Subject RE: Flax Pond Tim, Attached is the Comcheck for Mechanical. Can you confirm that you have received all pdfs? All trades COMcheck Software Version 3.8.0 Mechanical Compliance Certificate 2009 IECC Section 1: Project Information Project Type: New Construction Project Title : New Lodge Building at Flax Pond Construction Site: Flax Pond Recreational Area Town of Yarmouth Yarmouth, MA Owner/Agent Town of Yarmouth, MA Yar o^ MA Section 2: General Information Bung Location (for weather dater. Yarmouth, Massachusetts Climate Zone: 58 Section 3: Mechanical Systems List Designer/ConlractoF. Tom Wiltshhe Building Engineering Resources, Inc 28 Mae Street Buildup 3A North Easton, MA 02356 508.230-0260 twfishre@BER-Engmeering.Com Quantity System TM 3 Description 1 AH-1: Split System Heat Pump, Heat Capacity 48 kBWrn Cool Capacity 48 kBhub. Heat efficiency: 7.70 HSPF, Cool efficiency. 13.00 SEER / Sigle Zone 1 A14-2: Split System Heat Pump, Feat Capacity 22 kBW/h Cod Capacity 23 k8hub. Heat efficiency: 7.70 HSPF, Cod efficiency. 13.00 SEER / Single Zone 1 AWT Split System Heat Pump, Heat Capacity 33 kBhA Cad Capacity 36 kBbkl% Heal efficiency. 7.70 HSPF, Cod efficiency: 13.00 SEER / Singe Zone Section 4: Requirements Checklist Requirements Specific To: AH-1 : ❑ 1. Equipment minimum efficiency. Heat Pump: 7.7 HSPF 13.0 SEER 2. Heat pump thermostat required when supplanental electric resistance heat is installed Requirements Specific To: AH-2 : 1. Equipment minimum efficiency. Heat Pump: 7.7 HSPF 110 SEER 13 2. Heat pump thermostat required when supplemental electric resistance heat is Installed Requirements Specific To: AHJ : 1. Equipment minimum efficiency: Heat Pump: 7.7 HSPF 110 SEER ❑ 2. Heat pump thermostat required when supplemental electric resistance heat Is installed Generic Requirements: Must be met by all systems to which the requirement is applicable: (31. Plant equipment and system capacity no greater than needed to meet bads Exception: Standby equipment automatically oil when primary system Is operating ❑ Exception: Multiple units committed to sequence operation as a function of bad 0 2. Lfxnknum one temperature control device per system (33. Mmknmm one humidly, control device per installed huniddiraten/dehumid'dcatbn system 4. Load catadatons per ASHRAE/ACCA Standard 183 Project Title: New lodge Building at Flax Pond Report date: =13110 Data Nenanw. PMOM90rawirgs0eeElechical COMChedcock Page 1 of 5 ❑ 5. Automatic Controls: Setback to 55'F (heat) and WF (cook 7-day dock 2-hour ocagant owmide. 10•hour bac up p Excepdorr continuously operating zones p Exception: 2 kW demand or loss, submit calculations p & Outside -ail source forveriblatlo; system capable of reducing OSA to required mine Re p 7. R-5 supply and return air duct Insulation In unconditioned spaces R-8 supply and return air dud Ysulation outside time building R-8 Insulation between ducts and the buildup exterior when ducts are part of a building assembly p Exception: Duds located within equipment p Exception: Ducts with interior and exterior temperature dm8erence not aceedhp 15-F. p & Mechanical fasteners and sealants used to corned dots and air distribution equipment p 8. Ducts sealed - longitudinal seams an rigid ducts; transverse seams on as ducts; LIL 181A or 181B tapes and mastics p tO.Hot water pipe Insulation: 1 h far pipes �1.5 h and 2 h for pipes >15 h Chilled watarhefdperantibrins pipe Insuabon: 1 In. for pipes �15 In. and 15 In. for pipes M5 in. Steen pipe kwulatio: 15 h for pipes a1.5 h and 3 in. for pipes M.51n. p Exception: Piping within WAC equipment p Exception: Fluid temperatures between 55 and 105-F. p Exception: Fluid not heated or coded with mswable energy. p Exception: Piping whin roan fan -cod (with AHRI440 rating) and unit venb'latos (with AHR1840 rating} p Exception: Runouts 4 A In length. p 11.Opecatio and maintenance manual prodded to building owner p 12Balancing devices provided In accordance with IMC (2006) 603.17 p 13.Demad control ventilation (DC V) present for high design occupancy areas (>40 persoro 000 W In spaces s500 W) and served by systems with arty one of 1) an air -side economizer. 2) sNosBc modulating control of the outdoor dr damper. or 3) a design outdoor akllow greeter than 30DO dim. ❑ Exception: Systems with heat recovery. p Exceptio: Muttipla-une systems without DDC of individual zees communicating with a central control panel. ❑ Exception: Systems with a design outdoor airflow Was than 1200 dun p Excepdorc Spaces where On supply airflow rate minus any makeup or outgoing transfer ail requirement is less than 1200 dim. p 14.Mobrtzed, submetic shutoff dampers required on exhaust and outdoor ail supply openings ❑ EttaPlion: Gravity dampers acceptable In bufldrps d stories p Exception: Gravity dampers acceptable In systems with outside or exhaust air few rates Ica tan 300 chi where dampers are i tarlockad with fan p 15.Autamate controts fer freeze protecticrh systems preserht p 1 & Uft" air heat recovery Included for systems 5,000 dim or greater with more than 70% outside sir fraction or specifically exempted ❑ Exception: Hazardous exhaust systems, commercial kitchen and oboes dryer exhaust systems Get the Intenetarel Medunical Cade prohibits On use of energy recovery systems. p Exception: Systems serving spaces that are heated ad not coded b loss than 60-F. ❑ Exception: Where more than 60 percent of the outdoor heating energy is provided from ado -recovered or site solar energy. ❑ Exception: Heating systems In curates with ins than 3600 HDD. (3 ExcWdm Goofing systems In climates with a 1 percent coding design wet -bulb temperature Was than 54T. ❑ ExcePdeti Systems requiring dehumidification that employ energy recovery in emirs with the eo 6 cal ❑ Exception: Laboratory fume hood exhaust systems that have eltier a variable air volume, system capable of reducing exhaust and makeup airvol me b 50 pemerd a leas of design values or, a separate makeup air supply meeting the following makeup air requirements: a) at least 75 percent of exhaust flow rate, b) healed to no more tan 2-F below room eatpoid Wmperahue, c) coaled to no lower than 3-F above room sslpoi t temperature. d) no hmkMcadon added, e) no simultaneous heating and cooling. Section 5: Compliance Statement Compliance Statement The proposed medmi al design represented In this document Is consistent with the building plan, specifications and other calculations submitted with Ods permit application. The proposed mac ariml systems haw been designed to meet the 20W IECC requ karre ft In COMdsdt Version 3.8.0 and to amply with the mandatory mqukemmb In the Requirements Checklist Name -Title Signature Date Pm)ed Tice: New Lodge BuOdng at Flex Pond Report date: 08M3110 Data f lereme: P.1100 VDnew'igsW3ae 1ectrical COMChedLeck Pape 2 of 5 COMcheck Software Version 3.8.0 Mechanical Requirements Description 2009 IECC The following fist provides more detailed descriptions of the requirements In Section 4 of the Mechanical Compliance Certificate. Requirements Specific To: AH-1 1. The specified heating and/or cooling equipment Is covered by the ASHRAE 90.1 Code and must meet the following minimum elfidancy: Heat Pump: 7.7 HSPF 13.0 SEER 2. Heat pumps having supplementary electric resistance heat must have controls that, except during defrost, prevent supplementary beat operation when the heat pump can meet the heating bad Requirements Specific To: AH-2 : 1. The specified heating and/or cooing equipment is covered by the ASHRAE 90.1 Code and must meet the following minimum effidenc .. Feat Pump: 7.7 HSPF 110 SEER 2. Heat pumps having supplemerrtary electric resistance heat must have conhuls ghat, except during defrost prevent supplementary heat operation when the heat pump can meet the heating bad Requirements Specific To: AH3 : 1. The specified heating and/or cooling equipment is covered by the ASHRAE 90.1 Code and must meet the following minimum efficiency. Heat Pump: 7.7 HSPF 13.0 SEER 2. Heat pumps having supplementary electric resistance heat must have controls treL except during defost prevent supplementary heat operation when the heat pump can meet the heating bad Generic Requirements: Must be met by all systems to which the requirement Is applicable: 1. AA equipment and systems must be sized to be no greater than needed to meat calculated bads. A single piece of equipment providing both heating and cooing must satisfy Of provision for one function with ire capacity for the other function as small as possible, within available equiprtment options. Exception: The equipment and/or system capacity may be greater than calculated bads for standby purposes. Standby equipment must be automatically controlled to be off when the primary equipment and/or system Is operating. - Exception: Multiple units of the same equipment type whose combined capacities exceed the calculated bad are allowed 9 they are provided with controls to sequence operation of the units as the bad increases or decreases. 2. Each heating or cooling system serving a single zone must have its sum temperature caned device. 3. Each huni?dicatio system must have its own humidity control device. 4. Design healing and wring bads for the balding must be determined using procedures In the ASHRAE Handbook of Fundamentals or an approved equivalent calculation procedure. 5. The system or zone control must be a programmable thermostat or other automatic control meeting the following criteria: a) capable of setting back temperature to 55F during heating and setting up to 95F during coding, b) capable of automatically setting back or shutting down systems during unoccupied hours using 7 different day schedules, c) have an accessible 24mwr occupant override, d) have a battery back-up capable of maintaining programmed settings for at bast 10 hours without power. - Exception: A setback or shutoff control is not required on thermostats that control systems serving areas that operate continuously. - Exception: A setback or shutoff control Is not required on systems with total energy demand of 2 kW (8,928 Bbk' h) or less. 8. The system must supply outside ventilation air as required by Chapter 4 of the Intemalicnal Mechanical Code. If to ventilation system Is designed to supply outdoor -air quantities exceeding minimum required levels, the system must be capable of reducing outdoor -air flow to the minimum required levels. 7. Air duds must be insulated to the following kmis: a) Supply and return air dunce for corddioned air located in umbndctoned spaces (spaces neither heated nor cooled) must be Insulated with a minimum of R-5. Unconditioned spaces include attics, crawl spaces, unheated basements. and unheated garages. b) Supply and return ale ducts and plenums roust be Insulated to a minimum of R-8 when located outside the building. c) When ducts are located within exterior components (e.g., floors or roofs), minimum R-8 insulation is required only between the duct and the building exterior. Exception: Dud insulation is not required on ducts boated within equipment Exception: Duct insulation is not required when to design temperature difference between the interior and exterior of the dud or plenum does not exceed 15F. 8. Mechanical fasteners and seals, mastics, or gaskets must be used when connecting duds to farts and other air distribution equipment, Including multipbzone terminal units. 9. As Joints, longitudinal and transverse seems, and connections In ductwork must be securely sealed using Project Title: New Lodge Building at Flax Pond Report date: 08/13/10 Data filename: P.11003TDrawings10aeEledrkai COMCheck.cdk Page 3 of 5 weldnnera: msdnanlcal lastenens with seder gaskets, Or rnes I mash and mastic sea6g systems: or tapes. Tapes and malice must be Fated rd labeled In accordance with tfL 1I1A and" be marked Y91A-P for pnmwe sensitive tape, '161A49 for emetic or'181A-Ff for hest-asrwitivs tMw Tapes and mastics used to seat flexible sir ducts and tlaable at wmecto s shell campy with I.A. 1818 and shall be marked'1e1&FX for preasus aenalllve we or Y5113-W for madc. Unlisted dud bps knot pand0ed as ■ sedrd on awry metal ducts. - 10. N pipes serving specemrattlriq system must be iwleled as lo0owc Hat water piping for heating systems: - 1 12 b. la pipes at 12da nrriml darneter, 2 In. far pipes 3-1 124L nmrknd dmmoler. Chilled water, refiterarnt, and brie piping systems: 1112 iL irwAstim for pipes Qi 12arL nmiml dlaroter, 1112 iL kwlabon for pipes>1 12-kL remind diameter. SEssm piping: 1112 In. Im ailedon for pipes a1 12-kc nominal diameter, 3 ire. kwdadon far pipes M 12ic non6 diameter. Ficeptim Plp r kw idiom Is not required for bdwpksWW piping will L WAC egWprmerd. - Exceptions Pipe Insulation Is not required far piping Mat convays Olds having a design opera ft temperable range between 55'F end 105'F. - Exeeptiac Poe irsubtim is not required far piping that coveys Bids Oat have not been heated or coded Iaamym amuse of fossl hook or electric peear. - Ettaptim Piping will man fencnfl (with AHRI440 eating) and unit ventilators (with AMUO ratlng} - Exception: Papa insulation Is not required for veut piping not exceeding 4 it in length and 1 h km diameter betsao ere coil h valve and WAC col - 11. Operation and mei tsmanee documentation must be provided to the wwwwr Owt Intrudes at hod the fo0ming Information: a) equipmad cai NJ (sM ernd oulix4 end requhsd wmiitenance ediorm b) equor ent operation rhd mairdamnce nennals c) WAC system canteseWom desaiptlam; desired vteld-datom6ed let points mast be pemhaently recorded on oanbd drawbps, et control devices, err. fa digital control syaterne, in ix grm dnilsum meta d) coi to narrative of haw each system Is I Aw ad to operate. 12. Balancing devices provided In errndance wlh PAC (2006) 60:i17. 13. Demmnd eonbd vembtim (DCV) required far Hph design oeuprxy areas (>40 person /1000 a2 in spaes >M f12) rat served by system wM wW os of1) a amide ocor m tear. 2) auWmeft mod iatng combat of the outdoor air damper. or 3) a design atdoor Wow greater am 3000 des. -. Exeeptiam System with had rseway. Exception: Muitip&m m syaterns widW DDC of individual rasa communicating with a cehkal control paced Exception: System with a design outdoor airflow leas tan 1200 dm. Exceptiwc Spaces whets Oe supply airflow rats miens any makeup err outgokg b—.W ak reWhmwd b less #mn 1200 obey 14. Outdoor air nypy end exhaust systems mud have motion ad dampers Ind rlanmtiu0y dad when am system or spaces served am not in here. Dampers must be capable of sulmmtically shuMV nil during preoccupancy building wemwp, cool -down, and seasick, except when vemgatlan reduces ernargy costs (a.g.. night page) or when vwtkdm must be suppled io mad code mskwnwdL Both outdoorair supply and exha W air dampens must have a nuo mum leakage rate d 3 erne@ at 1.0 In w.g. wino bstad In - accordance with NAG Standad 500. Exception: Gravity (nomnw0orirad) dampers are acceptable in buildings less Ism tires stories in height. - Exception: System wM a design outside i Wake or exhaust tspacily of300 chn (140 tie) or less Vet are equipped with. otor oparsted dampers test open and doss when the unit Is wwm and and de-eergimd, respectively 15. Al }ream profectm systems, Yhemmng self-regu Main heat backg, must Muds wfotmfc ash- I cape.. of s of ing off the system when outside i brnperahres are above 40'F or when an connditiom _ of to prdeced Oral VA prwwerd beeziit. Srokr and ice-rnallig system must instate nulamte , ' M capable of sfaMig off On systems when tie pavemwd temperature Is above 50'F and no pni ipilatian is fa6rg, eat an adane0c ormaul wnbd Oat willallow shutolf when go outdoor iarpeaiaa b above 40'F. - 16. IndNidual fan syalem vft a deign supply air capacity of 5000 cm or greater and milnaon outside i supply of 70 parcel orgmatar of tine supply i capacity mad have an energy n ewway system with at bat a 50 percm effee5veness. Where wafig with outdoor i Is required two is a mom to bypass orcmad am energy recovery system to perm cooling with outdoor i. Exoepgm Harardo s exhaust system, mmoroW itdon rat dames dryer adnsuat system time Os International Mechanical Code prohibits am use of energy n xxwwy systems. F�rceptlon: System serving spaces tint we heated and not coaled to less am 60'F. Exception: Whets more son 60 parcel ofthe outdoer I " energy b provked tom sae4acoversd or site solar energy. Exception: Heading systems in chnmates with less than 3600 HDD. Project Title: New Lodge Bur Um at Fla Pad Report dab: OBM3fit Data Senses: P.11 W3NNe wigaOseElecikal COMChadLcck Page 4 of 5 . ' Exeeploe: Cooling sysWm in tirades with a / percad eooGq design weWm b WrgaraWm less than 04T. EaupBoc Systems nxp* V defamuclificallon that engky arlerYy recovery in series with No malrg col Exceptluc Laboratory hoe hood @Omni systems that have Where variable akvoknne tydm capable d radnri - adrenal and makeup airvokirm to 50 parted or lessd design vakm or. a separate make W ciarpply umig the blowbg mWwp r nmiukenerds: a) st lessi M parcad of admad soar rate, b) heated Iona more than 2'F baker roan selpokd Wrgerabae, c) coded to no lower than TF above room �d Wrgerebae, d) no hmdMcetion eddad. e) no skm t nmm heads and coaK . Project Us: New lodge Balding at Flat Pond Report date: 08113M 0 Data Sermw Pm omoomwkgsoeezlectrkal COMCtedccck Page S d 5 rr Y� Ut• I A1010trult f- -HkiI �3' Bi'ILDIY DE:P.1RI'31eV (' it 46 Rnu(e 28, tioulh 1'urrttuttlh, 11.1 11:662 Permit Number a •N� �i;• �' fu8-378-2211 e.t. 261 V1% 5118-i'M-0936 Date Is sued Expiration Date e, Pursuant to C.L, TRENCH PERMIT 82A fI and 520 CMR 7.00 et seq.(u amended) nits P[RNrr �f(rsr aF Name ofA E-ULLV CO:HPLCMD PRIOR TO CONSMFitA�N pplk'orK Town of pt. Street ►� 99 Buck =Water De Phoa 7921 s08-771_ Ceu L7ty?o�nWeat Yarmouth NA' Up 02673 Sirm Addrm Town of Ya I Pfione—�— 99 Buck rmouth Water Dept, Island Road 508-771-7921 West Yarmouth ,rr _ 1 03673 Street ?1 PkM "'o Purpoa of frsPssed (reneA: -- • •� Recentd Nu Yes describe be easel kestlon sf the be Isld In Proposed trenrA I PfOP°srd teeneh sad Its purpose (hsebrde a Newa. Plpea/wbk Iran etc-) Pkaseyuse env. if addiUoiol��s �r�t d for 4 inteodedl b Ha of p� /� y�/ lO Psee Is needed No O.AS Inaw7nee l'ertifirst. r: Town of Yarmouth -self insured 'and ('ontaN Infnrnytbn of Insurer: _ Pam Barnes - 508-398-2231 ext.: 270 - - - ^- -�.�.�.: aaiar3tla81 Nuns of t'omprtenl Prrwa as defir by l of 2 TOWN OF YARMOUTH 1146 ROUTE 28 SOUl7i YARD101 111 MA.SSAMUSEI'IS 02664-4451 + Telephone (508) 398-2231, ExL 250 — Fax (508) 398-2365 MEMO TO: Police Department Building Department Fire Department Health Department Board of Assessors Board of Appeals Tax Collector Water Division Town Clerk Planning Board Recreation FROM: Engineering Divisionoqa SUBJ: Address Change — Flax Pond Recreation Area Date: May 5, 2011 k f- C�; ENGINERIIVG DIVISION Because the access to the Flax Pond Recreation Area has been moved from North Main Street to the end of Dupont Avenue, the new address for this parcel, shown as Assessors Map 100, Lot 1 is now: 31 Dupont Avenue Please edit your records accordingly. Thank you. OK- Fib IN Uc6%(01J Ear` Pw Rayded PaW Date��i�; TOWN OF YARMOUTH BUILDING DEPARTMEN 1146 Route 28, South Yarmouth, DNA 02664 SIGN PERIVUT APPLICATION TOWN JUN 28 7nll JUL 01 2011 CUILOING Cc?T Permit No. 2 —,m Aimlicant Instructions I TOWN ADMINISTRATOR 1) Applicant shall complete both sides of application. 2) One application form is required for each type of sign. Each sign will be assigned its own permit number. 3) Applicant shall attach a separate 8 Wx 1 I" sheet including two diagrams: A) Design, dimension and colors of the proposed sign(s) B) Freestanding Signs: Indicate location of the proposed sign(s) with setbacks from property lines that are at least 6 feet. Attached signs: must show running footage of portion of building frontage occupied by business. 3 /Dvpolvyv Location / Address for or000sed sionlsl . nr r e A A _ _ C , n n Assessor's Map Lot Zoning District: B1 B2 B3 Res Hist.Dist Name of Business for proposed Name(s) of Business owner(s) C.,rt, n • S�) ,dwooap ST.)�r.q To u� MA pf4 Mailing Address of Business owner(s) S'f 0 w,.; a's F- Q, Z r„ All I 2043 019 r^O ;N Sr S �' nc r-0 I 0,t .re . rCT01.e 01�.c5 Business Owner(s) Phone: Business 9(%-rE WQn.s E N Home. _S Aw.6' 15Q*-137-o,S7 Name of Building Owner(s) 'ro w N 0 F Y n� «.o ,. rt_ Phone Soo • 39 zs _ s23 I / g,. — eve- vLI„f r-a TCrS SignBuilder_S',.,., q 0.a e f S Clr S,3 Sign Materials�at�a _ s ,,A.,F Sign Builder Address Ise t,,l Tc PC%-r,_,y� yg �e� Phone_SoF ygF _1 Internal Light External Light Freestanding Signs) Size of proposed Freestanding Sign: S 0 >c 3 C, r Attached Slen(s) Size of proposed Attached Sign: Temporary Sign(s) I Size of proposed Temporary Sign I Dates of proposed F• - Fr•/ 13 / /, Please complete other side of Sign Permit Application 2 All Permits are subiect to the approval of the Sign Inspector I hereby agree to conform to the proJisions of Town of Yarmouth Zoning By-law Section 303 governing sign construction and installation. I further agree that this sign will not be altered, added to or changed in anyway unless a new permit has been issued. Sign Permits are not valid until the Building Commissioner issues Use and Occupancy Permits (where applicable). Signature of Applicant: \-'-- DateG /s & / 1, Property Owner Authorization: I hereby authorize the applicant to act on my behalf in all matters related to this sign application. (signature) Date This Permit Replaces Approved by: 1 have read and understood the conditions of this Sign Permit listed above: Date Faml*ly-Q,&-o Caml'Oval-,,,v-jo Rides — Games-a,LA- Food - atttr JOHN STMPKTNS FIEIJD,kt° RTE. 28 - S . YARMOUT11w AUG. I I , 12, 13-Rfa 6PM — 10 PM-Glc;dr TOWN OF YARMOUTH 1146 ROUGE 28 SOUTH YAR.NOuni NASSACHUSETrS 0266"51 DIVISION Telephone (508) 398-2231, ExL 250 — Fax (508) 398-2365 FILE COPY MEMO TO: Police Department Fire Department Board of Assessors Tax Collector Town Clerk Building Department Health Department Board of Appeals Water Division Planning Board Recreation FROM: Engineering Divisional t SUBJ: Address Change — Flax Pond Recreation Area Date: May 5, 2011 14 0 5 2011 CU;LC:\:; '-;c;JT Because the access to the Flax Pond Recreation Area has been moved from North Main Street to the end of Dupont Avenue, the new address for this parcel, shown as Assessors Map 100, Lot 1 is now: =DupontAvenue Please 7t your records accordingly. Thank you. C'7� rt P�"�� P edwRcycled PoW TOWN OF VARiMOt T11 81'ILDI:NG DEP.IRrmEN7' I IJ6 Rowe 28. South Viernunt)h. \U 02664 =118-398-2231 to. 261 Fit% 508-398-11836 Permit Number Date Issued Expiration Date TRENCH PERMIT Pursuant to G.L. c. 82A I and 520 CMR 7.00 et seq.(as amended) MIS PER.HIT Sft'ST BE FULLY COMPLETED PRIOR TO CONSIDIMATn)N .Nanworwppueons Town of Yarmouth Water Dept. I r"O1' 508-771-7921 Street Addres 99 Buck Island Road West Yarmouth '� 02673 Naas of Excavator [if different from applicant) Phone call Street Address Town of Yarmouth Water Dept. 508-771-7921 99 Buck Island Road West Yarmouth) i 03673 Please drsrribe the raced Iuotlow of the proposed fresh sod Its purpose Ilnrbde a descriptles of whet it I or is IMeesdsd) to Ibe Wd In proposed trench (ef) piparcable Bnes tic-) Flew saw reverse alde If a"llonal space to seeded. So oq-7 Insurance Certificate e: U' Town of Yarmouth - self insured !lame and Cenlaet Informailin of Insurer:` -'- Pam Barnes - 508-398-2231 ext.: 270 i as defined by i of 2 To%I*N OF Y.MMOU'1'11 )-00 bg4'NR+1 I+r`Adµ f 17RPp 2 BUILD , Sc.ING DEPAR r�IEN r Permit Number r� , 4 1126 Rnute 2s. tinurh 1'arruuuth. 11-A 02664 =113.398_223I err.26t Fa<<nB-J9s-nA}6 Date Issued e "~ Expiration Date TRENCH PERMIT Pursuant to G.L. c. 82A f I and 520 CMR 7.00 et seq.(as amended) nM PERMIT .%ItrST at FULLY COSIPLETED PRIOR TO CONSIDERA770l4 Town of Yarmouth Water Dept. sae 508-771-7921 SermAddre99 Buck Island Road ""Vest Yarmouth MA ZIP 02673 WastafEaratelor(ifdlfrerevefrom applkantl Phone Sir#" Addrss Town of Yarmouth Water Dept. 508-771-7921 99 Buck Island Road West Yarmouthl I 03673 Strret Address 31 ' jlool* AM Pkss deaerlEe - user loots a o% tV r� r 111 be Wd In lrropethe tresrh f Proptsd m em and Ih A"P� lkrelada a deserlPtfan d rhnt k (oral Ieaended) to ta: PIPfuhk ass etc.l Pks rot retens"If addrtkrW rime 1e needed• cuF f Ali W P4Cr d ervice Lef+ 5 i de 1:wed drw�ewpq ldd/9 RdfAcelti io Nero lodge burl4f j sox (o nswb New afr h&ef' r4-- * ��co�'tas'o� ti a 400 � 7or� =07 lovilaiT cA rr9 st o p1Wv loo(7SX5o Town of Yarmouth - self insured Vtalr end CenUrt Inhmmsr4m a/ Inrenr� _ _ _ Pam Barnes 308-398-2231 ext.: 270 PM" F.tolnrMn Bur Dl14fe/. A--'� I" er ( empeleel I of 2 April 19, 2011 Flax Pond Lodge Building Recreation Area 383 North Main Street South Yarmouth, MA SUBMITTED TO: G & H Heating & Cooling 133 County Road Freetown, MA SUBMITTED BY: THOMAS—YOUNG ASSOCIATES, INC. 617 Mill Street/PO Box 567 Marion, MA 02738 (508)748.0204 AABC/ ACG CERTIFIED www.thomasyoungassodates.com TYA COPYRIGHT 2006 THOMAS—YOUNG ASSOCIATES INC. 617 Mill Street/PO Box 567 Marion, MA 02738 (508)748-0204 AABC/ ACG CERTIFIED www.thomasyoungassociates.com TEST AND BALANCE REPORT COVER SHEET PROJECT: Flax Pond Lodg Building Recreation Area PROJECT NO: 11-0097 LS�Zai>INP�1�ikl:Lu 77.F-Sr>F3■"'5..1 South Yarmouth, MA DATE: 4119/11 Architect Broom, Lindquist, Fenuccio 8 Reber 203 Willow Street. Suite A Yarmouth, MA 02675 General Contractor. NIA Engineer. BER 26 Main Street North Easton, MA 02356 Mechanical Contractor: G&H Heating & Cooling 133 Canty Road Freetown, MA TYA Form C3111i02 THOMAS-YOUNG ASSOCIATES INC, ADDRESS: 617 MILL STREET Tel. 506-748-0204 MARION MA 02738 Fax. 508-748-3873 TEST AND BALANCE REPORT CERTIFICATION SHEET Project Flax Pond Lodg Building Recreation Area Project No. 11-0097 Location: 383 North Main Street South Yarmouth, MA Date: 4119111 This Is to certify that THOMAS-YOUNG ASSOCIATES, INC. has balanced the systems described herein to their optimum performance capabilities. The testing and balancing has been performed In accordance with the standard requirements and procedures of the Associated Air Balance Council and the results of these tests are herein recorded. Z Amok r— ASSOCIATCO AIR aALANCC COUNCIL William IK Thomas, Jr. TBE AABC Certification Number AL 1 d � e TYA COPYRIGHT 2006 THOMAS—YOUNG ASSOCIATES, INC. PROJECT: Flax Pond Lodg Building Recreation Area PROJECT NO: 11-0097 ADDRESS: 383 North Main Street DATE: 4/19/11 South Yarmouth, MA REPORTINDEX Title Page # Project Information Sheet ................................... Page 1 Cover................................................... Page 2 Certification .............................................. Page 3 Index................................................... Page 4 Instrument Sheet .......................................... Page 5 Symbol Sheet.............................................Pages 6-7 Report Summary .......................................... Page 8 AH•1 Data Sheets .........................................Pages 9-11 AH-1 Data Sheets .........................................Pages 12-14 Page 4 TYA Form Cart 111/02 THOMAS-YOUNG ASSOCIATES.. INC J PROJECT: Flax Pond Lodg Building Recreation Area PROJECT NO: 11-0097 ADDRESS: 383 North Main Street DATE: 4/19/11 South Yarmouth, MA LIST OF L'NSTRUNIENTATION OWNED BY THONIAS-YOUNG ASSOCIATES, LHC. TO BE USED ON THIS PROJECT ID # INSTRUMENT CALIBRATION DATE CALIBRATION DUE DATE ADM-880C ADM-880C DIGITAL MULTIMETER 1/7/11 1/7/12 CFM-88L SHORTRIDGE FLOW HOOD 1/7/11 117/12 AM12921 AMPMETER (AMPS) 1/7/11 117112 K124201 TACHOMETER (RPM) EXTECH 1f7/11 1M12 AF-12806 AIRFLOW ANEMOMETER (FPM) lf7/11 lf7/12 MT-440K DIGITAL THERMOMETERS (DEG F) 1f7/11 1f7/12 FL63 NONCONTACT INFRARED (DEG F) 1/7/11 117/12 AL680 ALNOR WATER METER (GPM) 1/7/11 lf7/12 BECKMAN HUMIDITY METER (%RH) 1/7/11 lf7/12 B&K 1624) SOUND METER 1/7/11 IM12 WAVETEK VIBRATION METER 1f7/11 lf7/12 NOTE: INSTRUMENTS ARE TESTED ANNUALLY AT TYA LAB AND SENT BACK TO FACTORY IF DEVIATION EXCEEDS MFG TOLERANCE. DATE: 4119/ 11 TECHNICIAN: PeterMedeiros REMARKS Page 5 TYA Form Cert 111/02 ®THOMAS YOUNG ASSOCZASES_� INC. SYMBOL LEGEND AHU Air Handling Unit H.F. HEPA Fflter AC or ACU Air Conditioner Unit HOA Hand/Off/Auto Switch ACCU Air Cooled Condensing Unit H.P. Horsepower ADJ P.D. Adjusted Pitch Diameter HPS High Pressure Steam AMP Amperage HRC Heat (Recovery or Rediam) Coll AVG Average HVAC Heating, Ventilation and A.D. Alr Density Air Conditioning HWR Hot Water Return or B.H.P. Brake Horsepower Heating Water Realm HWS Hot Water Supply or C.D. Ceiling Diffuser Heating Water Supply CFM Cubic Feet Per Minute HX Heat Exchanger C.E. Ceiling Exhaust CH Chiller I.D. Inside Diameter CHWR Chilled Water Return CHWorCHWS Chilled Water Supply LAT Leaving Air Temperature C.R. Ceiling Return LD. Linear Supply Diffuser CC Cooling Coil LPS Low Pressure Steam CT Cooling Tower LT. Light Troffer CWR Condenser Water Return LWG Low Wall Grille CWorCWS Condenser Water Supply LWT Leaving Water Temperature DB Dry Bulb MAUlMUA Make Up Air Unit D.D. Direct Drive MBH 1,000 BTU's per Hour DIA Diameter D.NA Data Not Available NA Not Accessible D.N.L. Data Not Listed N.I. Not Installed N.L. Not listed EAT Entering Air Temperature WA Not Applicable EDC Electric Dud Col NZ. Nozzle EDH Electric Dud Heater EF Exhaust Fan O.D. Outside Diameter EMCS Energy Mgt Control Systems OPEN No Terminal Device Installed EWT Entering Water Temperature OAMin Outside Air Minimum OAT Outside Air Total FCU Fan Cog Unit FH Fume Hood PF Power Factor FG Floor Grille PHC Preheat Col F.E. Floor Exhaust or Return PH Phase(s) F.LA Full Load Amperage PIMP Grculating Pump FPB Fan Powered Box P.P. Perforated Plate FPM Feet Per Minute PSI Pounds Per Square Inch F.S. Floor Supply P.T. Pilot Traverse F.S.R. Floor Supply Register FT. HD. Feet of Head RA Return Air FTU Fan Terminal Unit RF Return Air Fan FTU Fan Terminal Unit R.G. Return Grille RHC Reheat Coil GPM Gallons Per Minute RPM Revolutions per Minute RTU Roof Top Unit HC Heating Coil HEATER O.L. Thermal Overload SA Supply Air Protection For Motors SAT Supply Air Temperature Located at Starer Motor S.D. Supply Diffuser HEPA High Efficiency Particulate SEF Smoke Exhaust Fan Arrestance SF (AIR) Supply Fan ®THOM—A� YOUN -MSOSLATES IN SYMBOLLEGEND S.F.(Elect) Service Factors SHC Steam Heating Coll S.P.1N.C.' Static Pressure Resistance Measured in Inches of Water Column S.W.E. Sidewall Exhaust S.W.R. Sidewall Return S.W.S. Sidewall Supply TAB Testing, Adjusting, end Balancing TSP Total Static Pressure UH Unit Heater V Volts VAV Variable Air Volume VD Volume Damper VFD Variable Frequency Drive VP Velocity Pressure W Watts WB Wet Bulb W.D. Water Density W.G. Water Guage F Degrees Fahrenheit AP Differential (Delta) Pressure or Pressure Drop AT Differential (Dena) Temperature, Net Temperature Decrease or Increase # PSI or Pounds Per Square Inch THOMAS-YOUNG ASSOCIATES, INC. PROJECT: Flax Pond Lodg Building Recreation Area PROJECT NO: 11.0097 ADDRESS: 383 North Main Street DATE: 4119/11 South Yamwuth, MA REPORT SUMMARY AH-1 and AH-2 are balanced within design specs. Peter Medelros Page 8 TYA Form Cart 1/1102 THOMAS—YOUNG ASSOCIATES, INC._ PROJECT: Flax Pond Lodg Building Recreation Area PROJECT NO: 11-0097 ADDRESS: 383 North Main Street DATE: 4119111 South Yarmouth, MA FAN DATA SHEET FAN NO. AH-1 FAN NO. SERVES MULTI PURPOSE ROOM MFR. YORK MODEL NO. AHP60D3XH21H SIZE 4 TON SERIAL NO. WIK0299900 MOTOR SPECIFIED TESTED SPECIFIED TESTED MFR. NL NL FRAME NO. NL NL HORSEPOWER NL 1 BRAKE HP NL 0.41 SAFETY FACTOR NL NL VOLTSIPHASE 240/1 24711 MOTOR AMPERAGE 7.6 4.1 MOTOR RPM 1050 1050 SPEEDS 5 MED HEATERSIZE NL CB HEATERAMPS NL CB FAN SPECIFIED TESTED SPECIFIED TESTED SUPPLY CFM 1600 1742 RETURN CFM 1200 1313 EXHAUST CFM NA NA OUTSIDE CFM 400 429 SUCTION PRESSURE NL -0.47 DISCHARGE PRESSURE NL 0.29 FAN STATIC PRESSURE NL 0.76 DCTERNAL PRESSURE 0.5 0.44 INLET VANEA/FD SETTING NA NA RPM SPECIFIED TESTED SPECIFIED TESTED FAN RPM NL DIRECT DRIVE MOTOR DRIVE SIZE/BORE NL IDIREMT DRIVE FAN DRIVE SIZE/BORE NL DIRECT DRNE BELTSIZE/NO. NL DIRECT DRIVE SHAFTS GC NL DIRECT DRIVE TURNS OPEN NL DIRECT DRIVE REMARKS Page 9 TYA Forth Cart 1/1/02 THOMAS-YOUNG ASSOCIATES, INC] PROJECT: Flax Pond Lodg Building Recreation Area PROJECT NO. 11-0097 ADDRESS: 383 North Main Street DATE: 4/19/11 South Yarmouth. MA TRAVERSE DATA SYSTEM: AH-1 TRAVERSE NUMBER : S-1 TRAVERSE LOCATION: SUPPLY DUCT DUCT SIZE (ROUND) ' DIAMETER Sq Ft = 0.00 DUCT SIZE (RECT.) 26 ' WIDTH x 10' DEPTH Sq Ft= 1.81 AIR DENSITY DATA STATIC PRESS @ CL• 0.29 InWg. DESIGN CFM = 1600 DUCT AIR TEMP 70 Deg F ACTUAL CFM = 1742 BAROMETRIC PRESS : 29.92 In Hg. SCFM= 1745 AIR DENSITY RATIO CORRECTION - 1.00 SCFM CORRECTION FACTOR 1.00 ACTUAL DENSITY 0.075 TEST HOLE 1 2 3 4 5 6 7 A 1265 1238 1024 600 598 B 1300 1269 1258 558 540 C D E F G H I NO. OF READINGS = 10 AVERAGE FPM = 965 J K L M N O P O R TECHNICIAN: PETER MEDEIROS Page 10 TYA Form Cart 1/1/02 THOMAS-YOUNG ASSOCIATES, INC. PROJECT: Flax Pond Lodg Building Recreation Area PROJECT NO: 11-0097 ADDRESS: 383 North Main Street DATE: 4119/11 South Yarmouth, MA AIR DISTRIBUTION SYSTEM: AH-1 SUPPLY X RETURN X EXHAUST ROOM OR UNIT UNIT AREAxK DESIGN ACTUAL DESIGN ACTUAL LOCATION NUMBER SIZE FACTOR FPM FPM CFM CFM NOTES SUPPLY 101 1 12 X 12 FH NA NA 190 206 101 2 12 X 12 FH NA NA 190 209 101 3 10 X 6 FH NA NA 190 211 101 4 10 X 6 FH NA NA 190 207 101 5 12 X 12 FH NA NA 80 84 101 1 6 12 X 12 FH NA NA 190 209 101 7 12 X 12 FH NA NA 190 203 101 8 10 X 6 FH NA NA 190 201 101 9 10 X 6 FH NA NA 190 208 TOTAL 1600 1738 RETURN 101 1 24 X 24 FH NA NA 1200 1313 O/A ATTIC 1 12' 0.79 506 543 400 429 REMARKS: Page 11 TYA Form Cart 1/1/02 ®THOMAS—YOUNG ASSOCIATES. INC. PROJECT: Flax Pond Lodg Building Recreation Area PROJECT NO: 11-0097 ADDRESS: 383 North Main Street DATE: 4/19111 South Yarmouth. MA FAN DATA SHEET FAN NO. AH•2 FAN NO. SERVES OFFICESISTORAGE MFR. YORK MODELNO. AHP30B3XH21H SIZE 2.5 TON SERIAL NO. WID0737614 MOTOR SPECIFIED TESTED SPECIFIED TESTED MFR. NL NL FRAME NO. NL NL HORSEPOWER NL 1/2 BRAKE HP NL 029 SAFETYFACTOR NL NL VOLTS/PHASE 24011 24211 MOTOR AMPERAGE 22 1.5 MOTOR RPM 1075 950 SPEEDS 3 LOW HEATER SIZE NL CB HEATERAMPS NL CB FAN SPECIFIED TESTED SPECIFIED TESTED SUPPLY CFM 800 862 RETURN CFM 600 648 EXHAUST CFM NA NA OUTSIDE CFM 200 214 SUCTION PRESSURE NL -0.29 DISCHARGE PRESSURE NL 022 FAN STATIC PRESSURE NL 0.51 EXTERNAL PRESSURE 0.45 0.27 INLET VANEIVFD SETTING NA NA RPM SPECIFIED TESTED SPECIFIED TESTED FAN RPM NL DIRECT DRIVE MOTOR DRIVE SMBORE NL DIRECT DRIVE FAN DRIVE SIZEMORE NL DIRECT DRIVE BELT SIZEINO. NL DIRECT DRIVE SHAFTS C-C NL DIRECT DRIVE TURNS OPEN NL DIRECT DRIVE REMARKS Page 12 TYA Form Cart 111/02 THOMAS-YOUNG ASSOCZATES�INC. PROJECT: Flax Pond Lodg Building Recreation Area PROJECT NO. 11-M7 ADDRESS: 383 North Main Street DATE: 4/19111 South Yarmouth. MA TRAVERSE DATA SYSTEM: AH-2 TRAVERSE NUMBER : S•1 TRAVERSE LOCATION: SUPPLYDUCT DUCT SIZE (ROUND) ' DIAMETER Sq Ft = 0.00 DUCT SIZE (RECT.) 22 ' WIDTH x 10 ' DEPTH Sq Ft = 1.53 AIR DENSITY DATA STATIC PRESS CL• � InW . 9 DESIGN CFM =P863 DUCT AIR TEMP : P29.92 Deg F ACTUAL CFM = BAROMETRIC PRESS : In Hg. SCFM= AIR DENSITY RATIO CORRECTION = 1.00 SCFM CORRECTION FACTOR 1.00 ACTUAL DENSITY 0.075 TEST HOLE 1 2 3 4 5 6 7 A 436 587 691 621 688 B 425 459 492 526 715 C D E F G H I NO. OF READINGS = 10 AVERAGE FPM = 564 J K L M N O P 0 R TECHNICIAN: PETER MEDEIROS Page 13 TYA Form Cart 111/02 THOMAS-YOUNG ASSOCIATES�INZ. PROJECT: Flax Pond Lodg Building Recreation Area PROJECT NO: 11-M7 ADDRESS: 383 North Main Street DATE: 4119111 South Yarmouth, MA AIR DISTRIBUTION SYSTEM: AH-2 SUPPLY X RETURN X EXHAUST ROOM OR UNIT UNIT AREAXK DESIGN ACTUAL DESIGN ACTUAL LOCATION NUMBER SIZE FACTOR FPM FPM CFM CFM NOTES SUPPLY 109 1 12 X 12 FH NA NA 75 82 103 2 12 X 12 FH NA NA 175 192 106 3 12 X 12 FH NA NA 25 27 107 4 12 X 12 FH NA NA 25 24 108 5 12 X 12 FH NA NA 50 52 102 6 12 X 12 FH NA NA 175 188 105 7 12 X 12 FH NA NA 25 27 104 8 12 X 12 FH NA NA 50 50 104 9 12 X 12 FH NA NA 200 216 TOTAL 800 858 RETURN 103 1 FH NA NA 175 190 102 2 FH NA NA 175 185 104 3 FH NA NA 250 273 TOTAL 600 648 O/A ATTIC 1 10' 0.55 364 378 200 208 REMARKS: Page 14 TYA Forth Cert 1/1102 EXPRESS BUILDING PERMIT APPLICA' TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 G (5088)398-2231 Ext. 12611 CONSTRUCf10N ADDRESS: _G 3 k.3 4j gel L % ASSESSOR'S INFORMATION: Map: OWNER: Z d "— NAME Residential Commercial Home Improvement Contractor IJe. # / / % Workmen's Compensation Insurance: (check one) I am the homeowner I am the sole Insurance Company Name: ❑ Teot (Fire Retardant Cenincue attached) ❑ Siding: g of Squares MUM r Parcel: 2t ? ADDRESS tyetce Use Umy Pervdt I7�5 Fee S Permit expires 6 months from Issuedaze MAR 1 1 2b11 BUILDING DEFT Jr TEL • ❑ Est. Cost of construction >e3 DOD - 7 ietor I have Worker's Compensation Insurance orker's Comp. Policy# WORK TO BE PERFORMED O Wood Stove Shed ❑ Replacement door. • ❑ Rcp1acentein windows: i ❑ Electrical Permit A 13 Re -roof•. • of Squam �/ �' 6 �.ir v/!w fi•� ,(f e/lliC7lasulatlon () Stripping old shingles- () going ovef_layers of existing roof - ❑ Old Kings Nithway/Hutoric District RoofinglSWing(Like for Like) 2-r 3 'The debris will be disposed 1 declare under penalties of perjury will be just cause for denia l or ne Applicant's Sigoww. APRnved Building befcW contained are true and correct to the best of my knowledge and belief. 1 understand that any false answer(s) and f, QL Ch. 268, Secdon 1. ; [/'>•^^'F Date: F Zoning DistrkC_a U Historical District Yes Flood Plain Zone: Yes Water Resource Protection District Within I \ 1� of Wetlands: yl!No -f-\ No PIT 1� El MIIA Property And Casualty Group, Inc, One Winthrop Square Boston, MA 02110 *1 �BEBHAME AND AppR�: YARMOUTH. TOWN OF $ UTH YARMOUTH. MA 02604 WORKERS COMPENSATION AND EMPLOYERSLA,,M 02 Sa4HTRACT PERIOD: FROM 07f01J2010 TO 07/0112011 AT 12:01 AM STANDARD TIME AT THE ADDRESS SHOWN ABOVE A Workers Compensation Coverage: Part One of the contract applies to the Workers Compensation Law of the Commonwealth of Massachusetts. B. Employer's Liability Coverage: Part Two of the contract applies 10 work in the Commonwealth of Massachusetts. The limits of our liability under Part Two are: Bodily Injury by Accident Bodily Injury by Disease Bodily Injury by Disease 31,000,000 Each Accident 31,000,000 Contract Limit 31,000.000 Each Employee Note: Contribution: The Contribution for this contract will be determined by our Manuals Of Rules, Classification. Rates, and Rating Plans. AN Information on the extension of Information page is subject to verification and change by audit. 94 1 SjSM$ AND ENDORSEMENTS ATTAC�Fn TO TICONTRACT: MWC 003 (0704j DEC 9, EXTENSION OF INFORMATION PAGE, M,IWC 001 (0799), MWC 002 (0799). (07/0112010) DEC PAGE 9 Olikee •queer ■1�i�u(•en • nut HOME IMPROVEMENT CONTRACTOR Rplstradort1.119113 - ' Expiratlon '1 11 - Trot Typ Ne,E lndf�p/I-1r �2� . ;II�HAROACOV�tL Y. . .s �ill;fkARD COUIi. '?T�it`*'�.:j . r! . 'oDrNjsPORT. MAo_ 2e7s + u.atrtttt_nry bfaswhosetts- Department of Public Safety . Board of Building ReguWeas and Standards' Construction Suwvla Lleniga r R•atricbdto: 00 •.i;.. ''��r,r .. RICFIARD IC COURTI� 1 SO INDIAN TRL ' DENNISPORT, MA 02839 f Expiration: SnTI2 12 ('wwn6Niwer Trm: 25W? FILE COPY SEEN BROWN L.INDQUIST FENUCCIO & RABER ARCHITECTS, INC. 24 February 2011 Mr. James Brandolini, Building Commissioner Yarmouth Town Hall 1146 Route 28 South Yarmouth, MA 02664 RE: Construction Control Progress Report No. 3 New Lodge Building @ Flax Pond Yarmouth, MA Dear Mr. Brandolini: MAR 0 2 RECT I U Since our last Construction Control Progress Report in early -January, we have conducted several additional site visits to monitor the construction work and adherence to our construction documents for the subject project. Since our last report, the following general work has been completed: ➢ All rough framing is complete. ➢ The rough mechanical, electrical and plumbing systems have been installed and the MEP engineers have conducted their rough systems inspections. ➢ Windows and doors are installed. ➢ The building is fully weather tight, the drainage mat (rainscreen) and siding work is complete. ➢ Insulation work is expected to begin soon and interior finish to start shortly thereafter. ➢ Roll -down security shutters have been installed. The work completed to date by Seaver Construction, Inc., and their subcontractors, has been completed in a good and workmanlike manner, and in general conformance with the drawings & specifications. All required town inspections for work completed to date have been completed. The structural engineer of record has visited the site to inspect tie -downs and anchoring hardware. All requested modifications were observed to have been incorporated by the contractor. Please find attached construction progress photos, structural report #3 and MEP report #2. If you have any questions, please feel free to contact me at anytime. 203 WILLOW STREET.SUITE A PH 508-362-8382 VARMOUTHPORT.MA 02675 WWW.CAPEARCHITECTS.COM FAX 508-362.2828 Sincerel Ric enueoio, Principal -in Charge CC: Jim Leger (Yarmouth DPW) Bill Cad (Seaver Construction) Dennis Mason (Seaver Construction) Tim Sawyer (BLF&R Architects), Project Manager i I I ALLEN & MAJOR ASSOCIATES, INC. 100 Commerce Way P.O. Box 2118 Field Report #3 WMAU1888-0118 Tell:: (78 (781) 935.6889 Fax: (781) 935-2896 Client: BLFR Report Date: January21, 2011 Project Flax Pond Recreation Area A&M Project #: 1203-36 Location: Yarmouth, MA Contractor. SeaverConstnxxion Weather. Clear Temperature: 25 Date of Site Visit January20, 2011 Time: From. 12.30 pm To: 2:30 pm Present at Site: Tim Sawyer (BLFR) Dennis Mason (Seaver) Brian Walsh (A&M) Reported by, Brian Walsh The following items from previous reports are outstanding or resolved as Indicated: 1.3 Cast -in holdown anchorage for the HDU5 and HDU8 holdowns are not in the stem wall per schedule on A/50.4. These anchorages will need to be drilled and set in Simpson AT adhesive. All anchors should be drilled, cleaned and installed in accordance with adhesive manufacturer's recommendations. All drill holes must be cleaned with a wire brush and compressed air. Drill depths provided here account for the reduced wail section at slab shelf and should be measured from top of foundation wall. Please notify BLFR/A&M in advance of drilling so that confirmation can be made of anchorage depth and preparation. Written report from testing company, and/or observation by BLFR/A&M, and/or photographic documentation will be required for drilled anchorages of HDUB's. 1.3.1 HDU8 holdowns, 7/8' rod,1' drill hole, 24' deep 1.3.2 HDU5 holdowns, 5/8' rod, 11116' drill hole,18" deep. 1.3.3 HDU2 and HDU4 perA/S0.4. [12-21-10]. Adhesive anchors had not been instalfed as of this observation. Additional Information regarding holdown and anchorage placement was included In a sketch sent to T. Sawyer on 12/6/2010 and was discussed with D. Mason prior to my leaving the site. 101-20-11]. 5/8 rod used at HDU8 holdown is Inadequate for uplift reaction at both sides of vestibule wall at grid line B. Install HDU2 holdown at each HDU8 holdown (4 civil R. structural engineers • land surveyors • environrxntal consultants • landscape architects www.allcnmajorcom locations). 3 locations the HDU2 holdown may be placed on the next adjacent double stud. In 1 location a double stud will be added. Note that the 518"diameter . rod for HDU2 holdowns need only be drflled 10" per above. 2.7 Required 3/16'x2-xZ' plate washers were not observed. In follow up phone call on 12/22/2010 to D. Mason, he confirmed that they would be installed within the limits of all shear walls. [01-20-11]. Plate washers are not installed on the following walls, grid line F grid line A and grid line Fan wall at plan right side. 2.8 Column bracing for the two full height PSL columns on the gable end (grid fine 1) require an alternate bracing detail to the one shown in detail 7/S5.1 as the columns were cut off below the top plate and not extended to the underside of the roof sheathing. An alternate detail will be coordinated and Issued as an SK [01-20-111. SK was discussed while In field. AdM agreed that the Zes attached to the side of the PSL posts were nailed appropriately. The screws and A341A35 dips will be Installed as per the SK The following was noted: 3.1 The HDU8 holdown at the plan right end of shear wall on grid line C is not Installed. An HDU5 is in place on an adjacent post 3.1.1 Nail the studs on which the HDU5 is installed to the actual shear wail end wind post with 16d nails at 4' o.c. for the full length of the post 3.12 Also install an additional HDU4 holdown at the shear wall end post utilizing a 5/8- diameter rod dulled minimum Ur into the foundation wall as per AIS0.4. 32 Shear wall at plan top along grid line 4 has the interior HDU2 holdown installed beyond the limits of the closet as per the note on drawing S3.1. In order for the interior plywood to terminate within the closet, this holdown must be relocated to the intersection of the closet wall on a double 2x wind post Drill new 5M" diameter anchor as per AIS0.4. 3.3 Shear wall at plan bottom along grid line 4 does not have the interior HDU2 holdown Installed. This must be installed. 3.4 In 5 locations the interior plywood on shear walls is not installed. 3.4.1 At the vestibule wails on grid line B (total of 2 walls). This plywood should be Installed on the vestibule side and nailed at 4' o.c. on all studs and top/bottom plates. This will accommodate the additional wind posts created In Item 1.3 above. 3.42 At interior walls along grid fine 4 (total of 3 walls), Install plywood to the limits shown on S3.1. All horizontal seams mist be blocked and upper and lower sheets of plywood nailed to the horizontal blocking. Plywood must extend up vertically to the underside of drag truss above and be appropriately fastened to the truss per detail 10/S5.1. 3.5 Except as specifically noted herein, the work Is observed to be progressing in accordance with the structural design documents. The above items were reviewed with the project superintendent prior to my departure from the site. Brian A. Walsh, P.E. Structural Department Manager Email: BWalsh(Mailenmaior.com 0 Paos 2 BIEIR SITE VISIT REPORT DATE OF REPORT: January21, 2011 RE: Lodge at Flax Pond Yarmouth, MA PERFORMED BY: Dan Wentzell — HVAC Paul Taylor— Plumbing Doug Curry — Electrical HVAC: 1. Air handling units have been installed in the attic. Hanging vibration isolators have been installed. 2. Approximately 90% of the supply and return duct mains have been installed, of which 50% has been insulated. Duct take -off to diffusers and grilles have not been installed at this time. 3. Duct hanger spacing appears to be consistent with SMACNA standards. 4. We could not verify if all of the ductwork has been sealed. All transverse joints and longitudinal seams require sealing. ELECTRICAL: 1. Rough wiring is underway throughout. Boxes are installed. Wiring has not been made up in boxes as yet. 2. Rough wiring to skylight operator; has not been installed. 3. Box for microwave in the Catering Kitchen is not installed. 4. Fire alarm wiring has been roughed. PLUMBING: 1. The water, waste and vent piping has been installed throughout the Lodge at this time. All piping has been tested and signed off; rough inspection at this time. 2. It was noted in the field that the two exterior wall hydrants and their associated 3/4" cold water supply with shut-off has not been installed at this time. 3. Temperature maintenance cable on all hot water as well as insulation, labels and flow arrows have not been installed at this time. 66 Main Street I North Fenton, Macsachuscas 02356 1 T 508130.0260 1 F 509230.0265 1 BF�I RBEReneineerinecom 1—B Clment PmjectsWunicipaPnu Pond- Lodge Big- 201MAdminTonstruction AdminTonxhuction Report -MeportASite Visit Report Jan 212011(1.17.11 V'uH).doc Ott ,•. .:: ',fit i t.� :-:. �,� _ ��Y �; y it .r • F�'ti` - -' if L• '� `mot � vi < r i` I - 4 s kin u u " Ll + j _ J � 2 V �..- �.__ �.;> i _ - F j _ _ _ G ' - Y a r TOWN OFYARMOUTH Building Department BUILDING (508) 398-2231 ext.1261 PERMIT NO : 8-11-�31__ PERMIT ISSUE DATE ;-1O121r201() ; PROPOSED USE ; APPLICANT`W'if1iarncad--------------------- -------------- - -----•....... JOB WEATHER CARD PERMIT TO ; New Construction ' AT (LOCATION) 0383NORTH MAIN ST ZONING DISTRICTR10 Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK 1100.1 BUILDING IS TO BE: CONST TYPE LOT SIZE excavation only - Flax Pond Recreation Lodge Building -Approval In Part as per CMR 780 Section REMARKS 111.13 _ AREA (SO FT) EST COST ($ 40.i OWNER OWN OFYARMOUTH ADDRESS 11146ROUI828 South Yarmouth I MA 102664 J PERMIT FEE ($) BUILDING DEPT BY INSPECTION RECORD USE GROUP A3 CONTRACTOR LICENSE 86387 215 Lexington Street Wobum MA 01801 7819350130 PHONE 150839=31 FIELD COPY Date Note Progress - Corrections and Remarks Inspector TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28. South Vartuouth. NIA 02664 SUS-393-2231 ext. 261 Fax 508-398-0836 Permit Number - Date Issued Expiration Date $50.00 TRENCH PERMIT Pursuant to G.L. c. 82A 41 and 520 CMR 7.00 et seq.(as amended) THIS PERMrr MUST BE nALY COMPMM FMR TO CONSmMT10N Nanr d Apoeso 7o WAr o or A,z ►to u f Peas. cell S<.«tAa D. P w, N��Hr�1f Y Di�Ji sow pit asi� 5vV;"7v- aNki Ciglrer" NA ZIP NametEannter(IftWrertfiecamppdeaM) Peo"a Cell street Address chyfrer" MA ZIP Nam" dow ral of Ptopergr -/inom 0VC �rtn �►ao-uf�i ehorr CCU Stred Addrefe 3 r3 No" TK01r41:0 5 T• C L ow) AdEA chyfrorw MA I ZR 5a Y44-w tkeer Car"" Permit Pee Raeelrad No q Yes DeeeelpBoR loeatbw awd pwpeee erpnpwW hweht Pbare deso the exact lautlow d dw pnpreed trench aad ib prpet (iwehrde • dae:iptlw d teat b let b IMewdedl b he bid In pnwued trench lei./ Npeak+W Gars eh-) Plese an man dde Uadd fiend Space Is weeded. D,9 � �sf qo/LS /a ,f-•uc� /{Rovu�/ p.4�,e �;,9 �e� ��,ca �- �o ' cOiE,EP r�/L �u�lr�i v9 soy/S i Bmwwweaenareaeear Perm" tat I r 1 of 2 3 Page 1 of 2 FILE COPY Allaire, George From: Pick Fenucdo [ridx@capearchitects.xxrmj Sent Thursday, April 29, 2010 3:15 PM To: Allaire, George; Tim Sawyer; BrardoiN, Jim Cc: 10sside. John'; DeFreitas, Peter, Armstrong, Pat Subject RE: Flu Building floor plan Tim 1,93 AleA7ff Can you please forward a .pdf file of Flax floor plan to George for his review with building commissioner Option One: 7SF per Occupant (Chairs Only) = 214 people at primary multi -purpose room Option Two:15 SF per Occupant (fables & Chairs) =150 people at primary mufti -purpose space However, based upon the current plumbing fixtures provided, we would need to cap the occupancy at 200 even, in order to stay in compliance with Plumbing Code The basic issue/ Questions which we were discussing last week when we met with Peter DeFrehas are: 1. Can the Restroom living' be deferred until funds are available and utilize the existing detached Restroom building to provide the required toilet facilities? 2. Can the new Lodge building be seen as an 'Accessory' Use to the overall outdoor Camp/ Beach Facility and then, by extension, can the detached restrooms meet the Intent of the building & plumbing code without the need for a state plumbing board Variance? 3. The existing building rChuckwagons) that is being removed does not currently have any toilet facilities, nor do any other existing buildings on site, and therefore, we would not be reducing the overall plumbing fixture count on the overall site 4. If the overall site is classified as a 'Pubric Beach l/se'then the current detached restroom building provides all of the required toilet facilities based upon the current camp occupancy limits (320 day campers + 48 staff= 368 Total (Note: 40 total staff and campers leave site every day with a real net on site maximum of 328) I will be out of the office tomorrow so if you need any additional information, please feel free to contact Tim Sawyer here at our office. Thank you . Rick Rick Fenuccio Brown Lindquist Fenuccio & Raber Architects Inc. 203 Willow Street Suite A Yarmouthport, MA 02675 p. 508-362-8382 Ext. 911 f. 50S-362-2828 www.caoearchitects.com 4/29/2010 '9_ 3 i4, yt t '7. 1 S� 7 ",9 - 3 on. TIMBER FRMx ERTRT STRUCTURE (ADD ALTERNATIVE) I I I .ALK-UI 1 "NOON W 1 NURSE'! —.—. 1—•—•—•—_—.—.—L STATIAI tT 40 STAFF OFFICE/ ' i CONFERENCE •. �—CURTAIN glib x 1 a r---I f I I ► i I I I 1 °Eo y� I I I 1 1 AI E0 1 L�aLJ NUR5E'5 h I I I �'IILJ _---- 1 SHARED QfF= -_— ICOVERED W-r Y-O• 1 IN r VENDING/ GE�7NR.I� yETMOOMI N, L I EwRT CAMP STORE ' silo x lb Is x ► 1 CL I O a I —•� —__ I OPENING D �" Q 0?MA' R.O. ---- FULL DSTAIR 11 L HALL NO. I CONTROL PANT r � '• HALL NO. 2 l] A� _ CHAIR M STORAGE ` , MECHANICAL HC STALL v ilOSET�. NC STALL eSS x O ---------- - - - --------------- ' EXTERIOR YYIN-UP—/ NINDLN • CATEINNG KITCNCN FUTURE PHASE 2 DECK EXPANSION a a I VESTIBULE D (AIRLOCK) _ r y ..• O M A O � 1 RECEP. AREA AttIC J SCYD0.� ___ I I I I _____L__J--- -r-'T--T--'1- I I I I 1 1 I I I I 1 1 —I I I 1 I I I I I 1!'bLJ I I I I I I I I I 1 I I � ItfbLJ LRIIILJ � I 1 1 I bS'aLJ FTwmmWT j �r.XE. r3s oVl — I FXFVMD I I �TM TIMBER j I yy 1 I CATERING 1 IKITCHEN 0 I 1 I I I I I 1 ATTIC I XYDDL9 I •BARN' STYLE SLIDER 000IE7 Ill" ABOVE L L CONSTRUCTION PROJECT TTuE LODGE AT FLAX POND YARMOUTH, MA ADDENDUM NO,1 r � (� [� � d � (/ TO: All Interested Bidders AUG 3 0 RECD D FROM: Brown Lindquist Fenuccio & Raber Architects, Inc. 203 Willow Strut, Yarmouthport, MA 02675 Date of Issue: 30 August 2010 Project: Construction of a Lodge Building at Flax Pond Recreation Area 383 North Main St S. Yarmouth, MA Owner. Town of Yarmouth, MA Notice is hereby given to all interested bidders, that the following revised Specification Sections, Drawing References, and/or Bid Forms shall supersede all previous sections in the Contract Documents dated August 18, 2010 as prepared by Brown Lindquist Fenuccio & Raber Architects, Inc., Yarmouthport, MA. Acknowledgment of this Addendum is required on the Bid Forms with all Bid submissions: I. Specifications: 1. Plumbing 15400, Page -2 Section 1.03, #6 - The plumbing contractor shall supply and install the electric temperature maintenance cable below the insulated hot water piping throughout the project from water heater to each fixture stop. Follow manufacturers installation requirements 2. Phmmbing 15400, Page -11 Section 1.08, #F — Pipe heat tracing shall be furnished and installed by the Plumbing Subcontractor. Power connections shall be by the Electrical Subcontractor. 3. Plumbing 15400, Page -21 Section 2.03 - The buried piping is to be cast iron with gasket joints per code. Above slab, the cast iron may bejoined by no -hub clamps per code. 4. Plumbing 15400, Page -38 Section 3.09 - The buried piping is to be cast iron with gasket joints per code. Above slab, the cast iron maybe joined by no -hub clamps per code. 5. Invitation to Bid,— Division of Capital Asset Management certification is required by all General bidders and Sub bidders. Addendum. #1 Brown Lindquist Fenuccio & Raber Architects, Inc. ADl -1 CONbT uenoN PRo = YARmouTH, MA THE LODGE ATFL Ax POND H, Drawings: A. On drawing A1.2 Add Alternate between grid lines 5 & 7 is incorrectly noted as #1. This add alternate should be #3. B. On drawings A3.1 Add Alternate between grid lines 5 & 7 is incorrectly noted as #1. This add alternate should be #3. C. On drawing A9.0 detail #1 is incorrectly titled "Casement Window Sill Detail". It should be titled "Exterior Service Counter Detail' D. On drawing S53 the deck framing plan does not note the required slope between grid lines C.8 & B as noted on the architectural plan, drawing ALL E. On drawing E1.0 pole 06 noted `°To be Removed" should be included in work to be done by others and is not to be included in the bid. F. The attached electrical sketch plan (SICE-1) shall be incorporated into the bid docrmments and will revise the specification for lighting fixtures located in Hall #1 & Hall #2. G. The attached architectural sheet (A9.1) was missing from the original bid documents. Sheet (A9.1) shall hereby be incorporated into the bid documents. Note sheet A9.1 has a revision date of &29/2010. Doors #11, 16, & 19 were on the plans but absent from the door schedule. These doors are now in the schedule but note that #5 is an unused door C -END OF ADDENDUM #1- Addendum #1 Brown Lindquist Fenuccio & Raber Architects, Inc. ADl-2 r L I S+ s I r I uwnc . B E R LODGE AT FLAX POND TITLE: reomLm msTFm=oArmPAB� Zic-H REVISED LIGHTING BmDr ENCDm>zaaG RES(XM= INc 203WLLOW SM= HALL #1 &HALL 92 . 28 Main Shet B14 3A 1240PtwaddAvemA YARMOUTHPORT.MA SKE-1 NaF"a%MAM336 EPmvidmc IUM16 TEL:(508)W2-MB2 DW .Ref. #: E200 TeL• (508)230-M Td• (401)054602 FAX(SOB)W2-= Fs (506)n"m Fs (CI)435�4608 DATE B-2110 DRAWN BY: SRO SCALE: 11841'-0' BFYa�F apaema6.mm Aw.ba-mpeamBsam LIGMWG FU(fUfiE SCHEDULE TYPE DESCRIPOON GT�ALDGER �� REMARKS NUMBER TYPE VOLTS WATTS A2 SAME AS TYPE "Al' IXCET4 DOTERENI IANP0IC ��� jF144-T128-W-02-I-CEO 1 2dW 120 73 FROM CEIl1N 0 TOP. � n _ FILE COPY n MEMO BROWN LINDQUIST FENUCCIO & RABER ARCHITECTS, INC. 15 November 2010 Mr. James Brandolini, Building Commissioner Yarmouth Town Hall NOV 16 2010 1146 Route 28 South Yarmouth, MA 02664 13UILDINGDEPT RE: Construction Control Progress Report No. 1 New Lodge Building @ Flax Pond Yarmouth, MA Dear Mr. Brandolinh Since the start of construction in early November, we have conducted several site visits to monitor the construction work and adherence to our construction documents for the subject project. As of this date the following general work has been completed: ➢ Construction staking by the town D Excavation for footings. ➢ Strip footings with reinforcing bars have been formed and placed. D The grounding connection was made with the rebar prior to pouring. D Foundation walls with reinforcing bars have been formed and placed. D Foundation wall damp -proofing has been installed. The work completed to date by Seaver Construction, Inc., and their subcontractors, has been completed in a good and workmanlike manner, and in general conformance with the drawings & specifications. All required town inspections for work done to date have been completed. Briggs Engineering & Testing have been on site to verify geotechnical soil bearing capacity, visual inspection of rebar placement, and to collect concrete cylinders. Please find attached construction progress photos and the geotechnical report. If you have any questions, Sincc Kurt CC: Jim Lefter (Yarmouth DPW) Bill Caci (Seaver Construction) Dennis Mason (Seaver Construction) Rick Fenuccio (BLF&R Architects) Tim Sawyer (BLF&R Architects) contact me at anytime. 203 WILLOW STREET, SUITE PH 508-362.8382 VARMOUTHPORT. MA 02675 W W W . CAP EA RC H ITE CTS. CO M FAX 508-362-2828 Briggs Engineering <& Testing A Driwwoy FRAmau= 1%r Brown, Lindquist, Fenuccio & Raber Architects, Inc. November 5, 2010 c/o Tim Sawyer Project No. 25501 203 Willow Street, Suite A Yarmouthport, MA 02675 RE: Geotechnical Borings and Report For Proposed Building at Flax Pond At 383 North Main Street, Yarmouth, MA 1.0 Project Description and Surface Conditions In accordance with your authorization on November 4, 2010 of our Proposal No. MA. 02.992.0, Briggs Engineering & Testing, A Division of PK Associates (Briggs) has completed our investigation of the subsurface conditions at the above referenced location and prepared this Geotechnical Report. The project site is located in the Yarmouth on the west side of North Main Street, between Melville Road and Great Western Road. A private road extends west from North Main Street into town property. Municipal facilities including wells are located on both sides of the private road. A camp is located at the west end of the road and overlooks a pond located downhill, west of about 5 wood framed camp buildings. Topography at the site is relatively level but slopes down moderately to steeply to the pond. The top of slope is located about 200 feet west of the proposed building. Topography within one mile of the site is undulating with mostly gentle to moderate slopes. The proposed construction is a one story wood framed structure with concrete slab on grade. An assumed allowable bearing pressure of 1.5 tons per square foot is indicated on the project plans. The primary purpose of this investigation is to evaluate allowable bearing pressure, seismic site class and liquefaction potential. The proposed building layout and immediately surrounding site features are shown on the attached Figure 1. Test borings were conducted to evaluate soil and groundwater conditions at or near the proposed building location. The subsurface conditions revealed via these explorations are discussed in this report as follows. 2.0 Subsurface Explorations The subsurface conditions at the Site were explored during this investigation under the supervision of the undersigned Briggs' Geotechnical Engineer. The explorations consisted of advancing two (2) test borings just outside the proposed building footprint. Refer to Figure 1 for exploration locations. Proposed Building at 383 North Main Street, Yarmouth, MA Briggs Project No. 25501 November 5.2010 Page 2 of 7 Desmond Drilling of Orleans, MA performed the borings on November 5, 2010 by. The borings were advanced using a truck mounted drill rig. Borings were advanced in accordance with ASTM D1586, "Penetration Test and Split Barrel Sampling of Soils". Standard Penetration Tests (SPT) were performed continuously. Borings were advanced using hollow stem augers and water head was maintained by injecting water through the augers prior to removing drill plug and/or sampler in order to reduce or eliminate blow-in of the sandy soils. Soil samples were field classified by David Geisser, Geotechnical Engineer on a full- time basis using the Bermister Soil Classification System. Soil descriptions by Briggs are presented in the attached test boring logs. Soil samples from all borings were retained by Briggs after completion of the test borings. 3.0 Subsurface Condidons Soils stratigraphy consists of topsoil over subsoil underlain by silty sands and sands over sandy silt These soil strata are discussed further below: Topsoil - Surface topsoil was observed in the side of the existing building excavation to a depth of approximately 6 inches. This layer was not sampled as it has been removed from the proposed building area. Subsoil - Subsoil was observed in the side of the existing building excavation, beneath the topsoil to a depth of approximately 1.5 feet or less. The subsoil is a silty sand with little (10 to 20%) non plastic fines (sift) and less than 1 % organic content based on visual and textural examination by Briggs. This layer was also not sampled as it has been partially removed from the proposed building area. Sand - Undisturbed sands were encountered from depths of 4 feet to 40.5 feet in B-1 and about 35 feet below existing grade in B-2. The sand is mostly fine to medium with no gravel encountered and trace to little silt content The sand is mostly light brown with brown to orange brown zones. SPT N Valuesl ranged from 4 to 12 in the sands. This indicates loose to medium dense relative density. Sandy Silts Undisturbed Sandy Silts were encountered in both borings below depths of 40.5 and about 35 feet in B-1 and B-2, respectively. The sandy silots are mostly non - plastic fines with little to some (10 to 35%) fine to medium sands. The sandy silts are mostly grey brown to brown with stratified layers of orange -brown to broom silty sands. N Values were 22 and 32 in the two samples recorded with the required 18-inch penetration. This indicates medium dense to dense relative density. Borings terminated in the sandy silts at depths of 41 and 46 feet. Refusals were not encountered in the borings. Hand written test boring logs are attached to this report Typed logs will not be prepared. 1 SPT N-Value Is the number of blows for a 140 Ib. hammer falling freely through 30 Inches, required to advance the standard split spoon sampler the last 12 inches of an 18 Inch sampling Interval. Proposed Building at 383 North Main Street, Yarmouth, MA Briggs Project No. 25501 Ndvember 5, 2010 Page 3 of 7 3.1 Groundwater Upon completion of each test boring and at later times up to 20 minutes later, a tape measure with hollow'plunker• device was lowered into the bore -hole to measure water that might have seeped into the borehole during penetration of the boring and/or after removal of sampling equipment. Groundwater was encountered in the boreholes at depths of 24 feet at B-1 and 23 feet at B-2. Boreholes collapsed within 30 minutes of removing augers and subsequent groundwater readings could not be measured. The measured water depths are consistent with the moisture contents observed in the test boring samples and are likely within a couple of feet of actual stabilized groundwater depth at the time of the investigation. Groundwater levels may be affected by local anomalous conditions such as underground utilities or confining silty or clayey soils as well as seasonal factors and thus may not represent the level to be encountered in the future. Generally, groundwater levels are highest in the spring and lowest in the late fall. Since the water levels were measured during the late mid autumn, groundwater levels may be about average and lower than springtime water depths. For design purposes, Briggs assumed high groundwater depth at 16 feet depth to calculate geotechnical parameters in Section 4 of this report 4.0 FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS 4.1 Foundation Design We recommend that the proposed building be supported on a conventional shallow foundation consisting of continuous wall and spread footings. We recommend that the footings bear directly on the inorganic, undisturbed, sands or compacted Structural Fill or Crushed Stone placed over the above stated undisturbed sandy deposits. Footings should be sized for an allowable bearing capacity of 1.3 tons per square foot (tsf). This is equivalent to 2600 pounds per square foot (psf). The allowable bearing capacity is for all combinations of live and dead loads with a 33 percent increase allowed for seismic and wind loadings. Strip footings should be at least 24 inches wide and isolated column footings should be a minimum of 36 inches. The bottom of all exterior wall or column footings should be a minimum of 4.0 feet below finished grade to provide adequate protection against frost heave action. The excavation to the undisturbed subgrade has been observed by the undersigned Geotechnical Engineer and is consistent with the bearing subgrade identified above. Should over -excavation below footing elevations be required to reach the undisturbed sandy subgrade, the excavation width must be widened to include the foundation stress zones. Refer to Sections 4.3 and 4.5 for details regarding excavation and backfilling in foundation stress zone areas. Proposed Building at 383 North Main Street, Yarmouth, MA Briggs Project No. 25501 November 5, 2010 Page 4 of 7 Total settlement due to the compression of the bearing soils should be less than 1 inch and the total differential settlement should be less than 1/2 inch and should pose no significant structural problems. Hydrostatic uplift is not a design concern as proposed slabs are well above groundwater and existing site grades. 4.1.1 Slabs It is our understanding that an 8 Inch thick lift of gravel borrow fill Is specified under the proposed slabs.Briggs has collected one sample of the site sand from the east wall footing excavation. This fill has less subsoil and is slightly less silty. At your request, Briggs can provide recommendations for blending this material with crushed stone to meet the specified gradation. Otherwise the sample is on hold, pending a directive by the client 4.2 Seismic Design The undisturbed sandy subgrade and compacted Structural Fill or Crushed Stone are not susceptible to liquefaction during the postulated seismic event given their gradation, depth to groundwater and relative densities. This evaluation is in accordance with the Massachusetts State Building Code, Seventh Edition. Tabulated spectral response acceleration coefficients, S. and St are listed as 0.19 and 0.052 for projects in Yarmouth per Table 1604.10 of the Code. Site soils and rock are Seismic Site Class E for the proposed building location. 4.3 Excavations The proposed footing areas, plus an additional 2 feet all around should be excavated to the undisturbed, inorganic, sandy bearing strata. The surface topsoil and subsoil must be removed.. Deeper over -excavation may be required if loose soils, fills or organic soils are encountered deeper. This condition was not encountered in the borings or open footing excavations and is not expected. Topsoil has been removed from the building area. Minimal depth of subsoil exists in the proposed slab area and should be removed to inorganic sands. Excavated sands and subsoil have been piled outside the building footprint Two piles along the east side of the building appear to be sands with about 10 to 15% fines. Two piles on the southwest and west sides are similar but have about 10 to 20% fines and more subsoil content The two easterly piles appear usable as Granular Fill. This material could also be blended with aggregate fill such as % or 1.5 inch crushed stone to create Structural Fill. Refer to Granular Fill and Structural Fill gradation specifications and additional discussions in Section 4.5. Groundwater was encountered below a depth of 20 feet Dewatering of excavations will not likely be necessary. However, dewatering might be necessary after heavy rainfall. Water control recommendations are presented in Section 4.4. Excavation to the subgrade should not be accomplished during heavy rains. Proposed Building at 383 North Main Street, Yarmouth, MA Briggs Project No. 25501 November 5, 2010 Page 5 of 7 4.4 Water Control Groundwater will not likely be a major concern for this project If groundwater is encountered after rain -fall, then limited pumping may be necessary. Crushed Stone wrapped in filter fabric should be used to protect the subgrade if the subgrade becomes wet This will allow future dewatering by sump pumping should water levels rise in the crushed stone. This condition is not expected. Otherwise no backfill on the subgrade appears warranted. The subgrade has been rained on and is not presently disturbed by the recent rainfall Gradation recommendations for Crushed Stone and Structural Fill are presented in Section 4.5. The crushed stone layer requires compaction by making at least 4 passes by a vibratory plate compactor or vibratory roller. Also, surface drainage should be directed away from excavations during construction so that the bearing surfaces do not become softened by water flow or puddling. Rapid water movement can also scour soils and undermine foundations, therefore surface water protection such as earth berms should be constructed. This can be accomplished with proper grading or construction of small dikes at the edge of the excavation. 4.5 Backrill and Compaction Excavated sands and silty sands may be segregated for possible reuse as Granular Fill or blended with aggregate materials to create Structural Fill as discussed in Section 4.3. Offsite borrow materials should meet the Structural Fill gradation except under non- structural areas such as landscape areas. The Granular Fill can be used Inside the building and against the interior side of foundation walls and under pavements and walkways at depths greater than eight inches below the base of slabs and pavements. Granular Fill is not suitable under footing stress zones or within three feet laterally outside the foundation walls. Exterior fill within 3 feet of the exterior walls and the final eight inches of fill under slabs and pavements should be Structural Fill. Backfilling and compaction must be accomplished 'in the dry'. Where water is encountered the water should be pumped while excavating and removing all muddy soils. The resulting subgrade should be covered by at least 4 inches of crushed stone on filter fabric and compacted. Subsequent backfilling may require pumping as the compaction will likely draw water that can often result in instability and fill moisture that Will prevent effective compaction. Within the areas excavated for footings, walls, and other limited areas where large compaction equipment cannot work, we recommend that the fill be placed in loose lifts no more than six inches in thickness and be compacted with small hand manipulated machines such as pneumatic compactors, vibratory compactors, etc. In areas where large vibratory compactors such as a Raygo 400A or equivalent can be used, we recommend that the loose lift thickness not exceed 12 inches. Proposed Building at 383 North Main Street. Yarmouth, MA Briggs Project No. 25501 November 5, 2010 Page 6 of 7 All backfill placed in load bearing areas including under slabs and under footings should be compacted to a minimum of 95% of the maximum dry density as determined by the test designated ASTM D1557. Structural Fill should consist of well 'graded natural sands and gravel free and/or crushed concrete, from excessive plastic fines, organic matter and deleterious material, and should have the following gradation: RECOMMENDED STRUCTURAL FILL GRADATION Percent Passing U.S. Sieve Size & Number Maximum Minimum 2/3 lift thickness 100 100 1 inch 100 60 No.4 85 25 No. 20 60 10 No.50 35 4 No.200 8' 0 ' 0 to 6% for backfill within 3 feet laterally behind earth retaining walls. Granular Fill should consist of well graded natural sands and gravel and/or crushed concrete, free from excessive plastic fines, organic matter and deleterious material, and should have the following gradation: U.S. Sieve Size & Number 213 lift thickness 1 inch No. 4 No. 200 GRANULAR FILL GRADATION Percent Passing Maximum Minimum 100 100 100_ 60 90 25 15 0 Crushed stone should have the following gradation: CRUSHED STONE Percent Passing U.S. Sieve Size & Number Maximum Minimum 1lnch — 100 314 inch 100 90 1/2 inch 50 10 3/8 inch 20 0 No.4 5 0 5.0 Limitations and Exclusions All the professional opinions presented in this report are based solely on the scope of work conducted and sources referred to in our report. The data presented by Briggs in Proposed Building at 383 North Main Street, Yarmouth, MA Briggs Project No. 25501 November 5, 2010 Page 7 of 7 this report were collected and analyzed using generally accepted industry methods and practices at the time the report was generated. This report represents the conditions, locations, and materials that were observed at the time the field -work was conducted. No inferences regarding other conditions, locations, or materials, at a later or earlier time may be made based on the contents of the report. No other warranty, express or implied is made. This report was prepared for the sole use of our client. The use of this report by anyone other than our client or Briggs is strictly prohibited without the express prior written consent of Briggs. Portions of the report may not be used independently of the entire report The above recommendations and conclusions are based on our evaluation of the obtained data presented in the text. We would welcome the opportunity to monitor the pertinent phases of the foundation construction; thus, if differences are found between the field conditions described herein and those encountered during construction, we can modify our recommendations in a timely and professional manner. Thank you for engaging our services to undertake this project. If you have any questions, please do not hesitate to contact us at your convenience. Very truly yours, Briggs Engineering & Testing USX 9F 4 4NO- 307 9 F6.7+rT£� NAL A ' David W. Geisser Project Engineer DWG:NAL:dg Enclosures Figure 1 — Site Sketch Test Boring Logs Nicholas A. Lanny, P.E. Professional Engineer !J EXISTING BATHROOMS BUILDING O EXISTING HYDRANT PROPOSED BUILDING B-1 FOOTING EXCAVATE 4 TO 4.5 FEET BELOW EXT ZRIORGRADES INTO UNDI RBED SANDS AND SILTY ANDS. TO POND B-2 TO NORTH MAIN STREET LEGEND: ON LOCATION PLAN ILDING AT FLAX POND BRIOOS Number and IN ST., YARMOUTH, MA approx. location jDale:Check: g/5 "-� B-z of test boring Drawn: DWG FlG.1 PMS Briggs Engineering & Testing ADWWL vfPKAyokdm./� Cape Cod Test Boring S Rayber Road, Orieans, MA 02653 (508) 240-1000 div. Desmond Well Drilling, Inc. 11 Project F(q k �on� �jQirt±OV 1 H� ?F 3 /J . Main Set-,. �Boring Baring No. - Sheet 1 of 1 - Driller Patrick Desmond Helper. William Urquhart Inspector. Dave GGtSSe.v location: !=Lf1)t F'orJD- yA,2mO, rr}, rA Ground Surface Elevation: Data start1OW010 Date end:1OW010 Sampler consists of a two Inch spirt spoon driven using a 140lb. hammer falling thirty Inches Notes: - IScreenSize: Auger Size: 6 W x 4' H.SA Casing Sae: WA N/A.. - Depth Sample Sample Description (FT) NO PEN/REC' DEPTRT-T BLOWS 6' -3 -10 -11 --12 13 -16 n-18 -19 "20 -21 -22 -23- -24- 1 • r , ,}Ii.. • 1L -���L.,t"'i"/�-r �IC.C''Jlpl �..•1 r�/ i - d'y - ssc� �Mj/gcC A,�il� ,- -C V SGnJr Z ' 4 . e; 1-7- Z- - - 25 -26 -28 -29 -30 -31 -32 -33 -34 g 1 j fo - �/ - _ Sq N d�y/fJ �, < <-.,k. •f 9 y tV •v` S n oi, lj ✓i9 , t vt SiA4 e 7 ro �i^^�v o End of sample: (j Groundwater encountered: 7 I - 1- 0-/2 .. aY -': Granular Soils BLOWSIFT DENSITY Cohesive Soils BLOWSIFT DENSITY Proportions Used Well Installation Key - -CONCRETE ED _SAND PACK - Z -SOILBACKFILL ® -BENTONrrE 11-SCREEN 0-APPROX WATER • 0-4 V. LOOSE 4-10 LOOSE 10-30' M.DENISE 30-50 DENSE >50 V.DENSE > 2 V. SOFT 2-4 SOFT 4-8 M.STIFF 8-15 STIFF 15-30 V.STIFF > 30 HARD Trace 0 -10% Little 10•-20% Some20-35% And 35-50% CAPE COD TEST BORING BORING NO. B1 I t' Cape Cod Test Boring 5 Rayber Road. Orleans. MA02653 (508) 240-1000 div. Desmond Well Dulling. Inc. Project I F14Lyt /qP two,—YQ✓nleov-1!1�! 141A 3 �3 N• rnal r1 5 Borin No. Z Sheet 1 of , Driller Patrick Desmond Helper. William Urqu Inspector. 1 (ScLQi Boring location: F' a 3 Ground Surface Elevation LI Date start 101W010 Date end 106WI0 Sampler consists of a two Inch split spoon driven using a 140II3. hammer falling thirty inches Notes: Size: 61/4' x 4• H.SA Itler ng Size: - WA Screen Size: WA Depth Sample Sample Description (FT) NO PEN/REC DEPTHIFT SLOWS6' _1 -2 3 •4 -7 -10 -11 -12 -13 -14 -15 -16 -17 -18 -19 -20 - ---------- -------- ------- -- Sa K c�- 'l/VC rib- L�V•C—/ r A / . S'IY a�'tcti Cr`• ,{ - 3 5 + 2 2 4/— Z-2 22 — .'t 10 15- 51 2- 2. -21 - _23 -24 -25 -26 _27 -28 -29 -30 31 -32 33 34 saw ^/ End of boring: Vr 4:� C End of sample: Groundwater encountered: .23 - Granular Soils BLOWS/FT DENSITY Cohesive Soils BLOWSIFT DENSITY proportions Used Well lnstaflabon Key -CONCRETE -SAND PACK Z .SOILBACKFILL ® -BENTONITE -SCREEN -APPROX WATER fEVrI 0-4 V. LOOSE 4-10 LOOSE 10-30 M.DENSE 30-50 DENSE > 50 V. DENSE > 2 V. SOFT 2-4 SOFT 4-8 M.STIFF 8-15 STIFF 15-30 V. STIFF > 30 HARP Trace 0 -10% Little 10-20% Some 20-35% And 35-60% CAPE COD TEST BORING ISORINGNO.Bl '�IN.pf• ARr BUILDING PERMIT APPLICATION 0 ?0 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE. CHANGE THE USE, OCCUPANCY OF, C OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. naffs y Town of Virnunuh Building Uepartlurnt YttKK 1146 Route 2R - liirtnouih. \1.1021'di-ht l!)_> Tel: S08.398-2231 ext.1261 Fax 508-398-0836 fJ '� n �Ke USe Only �J Planning Board Information Assessors Department Information: cci ermit `$N j l - U ( Pate Il j Pn Type Map Lot E ermit Fee $ ndorsement Date za / eposit Rec'd. S V� 0 1 Recording Date New Date _ Plan No. 1.4 Property Dimensions: Net Due $ OMer Lot Area (st) Frontage (B) Lot CoKnpe —020 11 Cartel of Occupancy e 6 Is not required aoc.uurt i - one mlormaucirl _ 1.1 Property Addrosa 12 Zoning Info atlon: 383 NORTB MAIN STREET Zoning District Proposed Use 1.3 Building sotbaoks (ft) Yards 1;�� 1.4 Witter Supply (ef.O.L c. 40.2 St) 1.5 Flood Zane INonretbn: COmmentic Public Private ZOM• BFE- n SeeUon 2 - Property Ownership/AuVarized Agent 21 Owner of Record: (prim) Name )el 781-935-0130 - , a - wnstrumon Services 3.1 Licensed Constnnetfon lupenrlson 215 LEbINGT N WOBURN. MA 01801 Andress M/ 781-935-0130 Mailing Address: Telephone Mailing Address: 781-935-0048 Fax . Not Number Expiration Date loft OVER 1.2 Registered oe.nnaq Masse Not AppleaDte Address EVI -1 lDate Sip>aMa TNeplgna Section 4 - Workers' COMPOnSacOn Insurance Amaalm lmu.L c r oc n xa, for 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 ... a.... No .......... Section 5 -Professional Design and Construction Services • for Buildings and Stnlctures Subject to Constnlctlon Conhol Pursuant to 780 CMR 116 (oonfalnlrfg more than 35.000 af. of endosed space) Section 5.1 Registered Architect MM. LI10 MST, PENOCCIO 6 BABES ABCBITECPS, MC. I Nor AMI b* ❑ --- 2-(f3 QILLoW s1'BEET, SUM A, wmouTpOBT, MA uzb75 n.p,u.ncn M,ewr Address (ctg 6W(,WCIa) ._.508-362-8382 Evtalbn Date A S MAJOR ASSOCIATES, INC. STBII4IIIBAI AIM or R.spwsW COMM6BCE WAY, P.O. BOX 2118 WOBDBH MA 01801 ReWevaban (�1 781-935-6889 ~ Llanhrt EXDWBMn Date CDM SITE al r A SOME BIDCE PLACE 50 HAMPSIIBE ST CAMBBIDCE. MA Address at GN.Grwo% 617-452-6000 RaodarJ { Name Address CaryaM 2of4 Date - Dale tection B - Oescrtptlon of Proposecl work (dwc* all WptleabW) New Comtruction ® Ihx muElpla hmly eNpt No GI Bedroorte our mw" hmb orm No. of Bomorm E*Unq Eft ❑ I sepalr(s) ❑ 1 ARerattam ❑ I Addition ❑ Accessory Bide. Q Type Demolition Other Specify: Brief Description of Proposed Work: CONSTRUCTION OF NEW LODGE BUUDING @ FLAX POND RECREATION AREA INCLUDING BUT NOT LIMITED TO MISC. N01tK S ROUGH S FINISH CARPENTRY INTERIOR FINISHED INSULATION S ii111DOt1S ROOFING HVAC PLUMBING AND ELECTRICAL SYST M A 3Z Section 7. use Grow and CGnatnxtloTl SWIArq Use Group (Owdc as WWApabfe) CGrugr xdm Typo A ASSfl10.Y p A-1 p M C3 A-2 p AG Aa Q fA in 1 p Q s sL; ;; Q 2A 28 2C O Q Q E EMCATKP" Q F FACTOM Q F•1 F4 Q N HIGH NATARG Q 3A 28 O p 1 Efe7nnXK4L I Q F1 Q u u M MERCW NTILE Q / O . R RESIDENTIAL Q &1 *2 E3 R,1 SA ss Q e STORAGE p 5-1 Q L2 u unuTY O Spec".. wen- RPM" w mumum O 3 spwmuw ❑ Esldrq uM mow. %✓ i-- IFupa.a uM o ww A 3 Fx1"m Nand r11eM m C1r u Plopoaad fto mu m cm u N~ dI amm ormorn ucam. ow..s W"w FowAMaw FbvM I Total AnaAEFlm (aft 2 7.00 Section to - STRUCTURAL PEER REVIEW R 11011 Ind@M Wll SaucLral EngMrMrq Savcasd Faar Ravhw Raearod YM _.Y... No ...__._ SECTION 102 OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMfT S property. — hereby authorize SEAVER CONSTRUCTION, INC. to act on my behalf, In,I matters relative to work authorized by this buildklg penTd application. 97ma . of omw Dar. 3ora OVER l• . as Owner/AudiortredAgert hereby declare that the statements and Inforrrmtlon an the forgoing apple agon are true and scurale, to the bat of my krwwledge and belief. Signed under the pains and penalties of perjury IFlrr Pie" I na.w I gladby P~ smax"I I 1 l Md1mda1 AlwQ a ►N ►foladlal l Told a It•a. 3.4 q T. TOW ll arl On.r ■rrr Cheek Below ❑ FAlry (- applc"ll ❑ ad Kbp tiv way a Hblorkal commlwlon approval (B appAc"ll oal. 4 d 4 j The Commonwealth of Massachusetts Department oflndustrial Accidents Office of investigations 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: BuUders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbiv Name(Businessmrganvation/Individualy S>AVER CONSTRUCTION, INC. Address: 215 LEMCM STREET City/State/Zip: WOBURN, M& 01801 Phone #: 781-935-0130 Are you an employer? Check the appropriate box: Type of project (required): 1. X I am a employer with 30t 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub -contractors 7. ❑ Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These 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 10.0 Electrical repairs or additions required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. e. 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 cheeks box a I must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they am doing all work and then hire outside contmetors must submit a new affidavit indicating such tCootractors that check this box must attached an additional sheet showing the name of the sub-eontnactors and their workers' comp. policy information. lam an employer that Isproviding workers' compensation insurance for my employees. Below Is the poUcy and fob site information. Insurance Company Name: ACADIA Policy # or Self -ins. Lic. #: NCA 0113328-15 Expiration Date: 04-01-11 Job Site Address: 383 NORTH MM STREET City/StateiZip: YAMMM. MA Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under S n 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 impriso nt, as well as civil penalties in the force of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance rage verification. I do hereby certify under the pains a4penalder ofperf ury that the Information provided above Is true and correce Phone #: 781-935-0130 Official use only. Do not write In this area, to be completed by cUy or town offlichrL City or Town: Permit/Idcense Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone TOWN OF YARMOUTH �S BUILDING DEPARTMENT Fy CONSTRUCTION SUPERVISOR FORM PLEASE PRIM. job Location: 383 NDBTN MAIN st RM Numocr Street Village Owner of Property: TOWN OF YARMDUTN Construction Supervisor. Name License No. Phone No. Address: Licensed Designee: W'UUM CAME 86387 (ezp 9/23/11) (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 Anylicensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother 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: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 If you have checked yg2, plea ndcate the type coverage by checking the appropriate box. A liability Insurance po a Other type of Indemnity ❑ Bond OWNER'S INSURANC AIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 152 of the Ma . General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Ow w or refs Ag-enl Owner Agent L Signature: Building Official Approval: TOWN OF YARMOUTH OT •YAR'i a O y BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter40, 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%b Q • NnA1y �t- Work Address Is to be disposed of at the following location: G' -gA-0A 1''rK{-(t,` Vr CMWP 74Trud 1�&M&W+ry afmcrer f wA OLO z-r Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter I 11, Section 150A. i✓ 4P Signature of AIIplicatkn Permit No. I7-pc,-r./O Date AGM CERTIFICATE OF LIABILITY INSURANCE mupoDwffm 8ElL�X 04 06 10 ►RONIDEA TH13 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DaSagatia Inausanoa A4o7f Ina. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAMEM EXTEND OR 36 Cummings park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Noboru MA 01901 Phcas:781-935-846o raa:701-933-5645 INSURERS AFFORDING COVERAGE °NAIC0 o I FEu "C.sanwar'Cpatcoa nd�l EnEAaWobM�AMUSIC' .. THE POLICES OF NFURANCE LISTED BROW NAVE PEEN ISSUED TO THE INSURED NAACO ABOVE FOR THE POLICY FERI00 INDICATED. NOTWITHSTANDING ANT RZOLa1EYEM7, TERM OR CONDITION OF ANY CONTRACT OR OMR DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTMA THE INSURANCE AFFORDED fYM FODCIES DESCRIED IEREN IS NARCT TO ALL THE TERMS, EXCURSIONS AND CONDITIONS OF SUCH POLCES. AGORSOATE UMffl ENDWN_MAY HAVE BEEN REDUCED BY PAID CLAMS LTR fRn TYPE OF INSIFRANCT ►OUL^TIMIISER TE IUD DIETS a.NAL.NMTT au utHOCCIliw" 11,000.0DO >• COMACCKDENIMMALRYA332316 ZOOCpm, IRIIn 04/Ol/10 * 04/01/11roP�a250 000 215000 33 _ ECC10100641201 04/01/10 04/01/11 PERSONAL 6 ADW WAW 11,000,000 GENERAL AGGREGATE s2,000,000 OENLA0011EOAT[ISRAPFLEBPER PRoomTS.001/17Aca f 2 0001000 Pollution Fl LOO lmil 3 mil AITrpIDNUUASLRY AM AUTO COIISNEDfNMEuar R'.ORHI $1,000,000 — BOOLTRLAAW Dtiral Al ALL OWED AUTO$ Y SCEMAEDAUROS kMO21332416 04/01/10 ' 04/01/21 B , BOOLY WAXY 2 wIEDAYTOS ;z IION&mmmmm f CARAaa UAIARY AUrOOHIr.uACCIDENT 13 OMRTHAN EAACC AUTO ONLY: AGO I ..... . f ARIAUTO EXCEMWRULALIAALRY EACH OCCURRENCE B10Doo 000 A ilowA npABMMAoE CUAL011332726 04/01/10 04/01/11 AGDREGATE f10 000 000 a _ I Dexcm". 1 I RETINrWN f B MIORNERSCDMPMATIOR AM >\ � yrELASALITT,I OIFICERAEMBER EXCLUDEDI WCADI1332917 i1A 04/01/10 R TW!Y 6 ER 04/01/21 cLCAiHACCmM AlS00 000 [L pSWl.G f500 DOD IsMm Pno Eowowl SRFT ,IL DISWE-POIICV LIM Is500 a a 0 OTHER OESCCNFTIOM OF OPIRAO"41 LOCATIDHS IWE ULS I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROMfIDA6 Evidence of Inauranaa ZVMZ-1 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES WCANCELLLD BEFORE THE EPRATPM OATETNERfoP,MISfUNGNnIRERwLLNouva To MAL 30 CA" mmIDI Noma To rxa CERTNCATE NOIDaR HAMED To THE LEFT. EWrFALURaTo Do so PIALL Ep1TDLNC6 OP INSORANCL IMPOSE NO CBIIGATION OR LIAaUPI OF ANY FIND UPON THE MURRR ITS AGENTS OR Board or Building Rt-gulations and Standards Construdbn Supervisor License License: CS 74MI Restricted to: 00,. , DENNIS L MASON ; PO BOX 462 ' DENNIS, MA 02eU -e'/-Yj�� Expiration: 32S2011 C.nwiL,"r r Tro: 134M • dV, TOWN OF YARMOUTH Building Department z Town Hall Yarmouth. MA 026rA (508)398-2231 ext1261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-11-163 Applicant Name: William Cac( Applicant Phone: 7819350130 Building Location: 0383 NORTH MAIN ST Owner's Name: TOWN OF YARMOUTH Owner's Addres 1146 Route 28 South Yarmouth MA 02664 Owner's Telephone: (508) 398-2231 REVIEWED BY: (OFFICE USE ONLY Recorded By. IC Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 10/19/2010 Issue Date: Expiration Date Comments: Map/Lot: 100.1 commercial new construction - Flax Pond Recreation Lodge Building as per plans dated and as per BOA petition # 4309 and 4312. ZONING APPROVED 1/i1a 1. WATER DEPARTMENT: DATE: WA: 2. ENGINEERING DEPARTMENT: DATE: WA: 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: DATE: WA: 5. BUILDING DEPARTMENT: DATE: WA: 6. FIRE DEPARTMENT: DATE: WA: COMMENTS: RECEIPT OF COPY. PLEASE NOTE SIGNATURE OF APPLICANT: DATE: Date Printed: 10212010 FILED WITH TOWN CLERK: PETITION NO: HEARING DATE: PETITIONER: #4309 July 8, 2010 G'k 24783 P9213 443094 08-27-2010 a1 03:16P TOWN OF YARMOUTH BOARD OF APPEALS DECISION July 16,2010 Town of Yarmouth PROPERTY: 383 North Main Street, South Yarmouth Map & Parcel: 0100.01; Zoning District: R40 Book & Page: 4738/242 MEMBERS PRESENT AND VOTING: Steven DeYoung, Chairman,, Sean Igoe, Diane Moudouris, Richard Neitz, Robert Howard and Bryant Palmer, Alternate. 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 is the Town of Yarmouth who appears by it's representative Peter Johnson - Staub & Patricia Armstrong, Director, Yarmouth Recreation. The Petition seeks relief under bylaw § 104.3.2 and, in particular, regarding Use N9 of the Use Regulation Schedule Bylaw §202.5. The relief is in connection with the planned construction of a "Lodge Building" (so- called) at the Flax Pond Recreational Area, 383 North Main Street, to be utilized as per the description contained in the June 15, 2010 Site Plan Comment Sheet -Project Summary. All members agreed that this municipal recreational facility improvement would enhance the site and the enjoyment and use by the community at large. The only relief sought by this petition was for a Special Permit allowing a use consistent with use schedule designation N9 as this facility is located in an R40 Zoning District. Beyond those presenting the petition, no one spoke in favor or in opposition and the Board received no exhibits. In light of the nature of the use of the proposed "Lodge Building" the Board all agreed that the requested relief would not cause any undue nuisance, hazard or congestion and that there will be no substantial harm to the established or future character of the neighborhood or Town. 4k Accordingly, on motion made by Mr. Igoe, seconded by Mr. Neitz, it was unanimously voted to grant the Special Permit as prayed for by the petition and without condition. No permit shall issue until 20 days from the tiling of this decision with the Town Clerk. This decision must be recorded at the Registry of Deeds and a copy forwarded to the Board of Appeals. Appeals from this decision shall be made pursuant to MGL c40A section 17 and must be filed within 20 days after tiling of this notice/decision with the Town Clerk. Unless otherwise provided herein, the Special Permit shall lapse If a substantial use thereof has not begun within 24 months. (See bylaw, MGL c40A 19) Steven DeYoung, Chairman 2 f:1• s s ��s FILED WITH TOWN CLERK: PETITION NO: HEARING DATE: PETITIONER: #4312 July 22, 2010 Bk 24820 P933 09-10-2010 A TOWN OF YARMOUTH BOARD OF APPEALS DECISION August 5, 2010 Town of Yarmouth PROPERTY: 383 North Main Street, South Yarmouth Map & Parcel: 0100.01; Zoning District: R40 Book & Page: 4738/242 045707 03241p m -h q o< nl 172 N Y� MEMBERS PRESENT AND VOTING: Steven DeYoung, Chairman, Sean Igoe, Debra Martin, Bryant Palmer and Richard Neitz. 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 is the Town of Yarmouth which returns by its representatives, Mr. George Allaire and Ms. Patricia Armstrong in furtherance of planned improvements to the Flax Pond Recreational Area facilities. The Petitioner recently received other necessary relief for its construction of a "lodge building" on the property located at 383 North Main Street, South Yarmouth, such property being located in an R40 Zoning District. It should be noted that property immediately adjacent which could be said to be the "most impacted" abutter to the requested relief is also property of the Town of Yarmouth and held as a well -field. The specific relief sought is for a Special Permit under Bylaw § 104.3.2 and §301.2 by which the Petitioner seeks a reduced buffer for proposed, expanded parking servicing the site from 20 feet (§301.4.4) to 10 feet or less. There were no members of the public speaking either in favor or in opposition to the grant of Special Permit. No exhibits were received. The correspondence dated 07/12/10 from Dan Mills, Superintendent of the Town of Yarmouth, Water Department, which stated the lack of objection by the Department to the requested relief. Reduction of parking buffers are, in most instances, an item that the Board generally would not look so favorably upon. _ However, it was duly noted that in this instance of which is essentially undeveloped abutting land which will not be the subject of development, it was reasonable to allow such relief when weighed against the lack of harm and the benefit of infrastructure improvement at this recreational facility. The Board found that the requested relief was reasonable and would not result in any nuisance, hazard or congestion and that, when the project was completed, the project would not cause the neighborhood or Town any harm. 11 Therefore, on Motion made by Mr. Neitz, seconded by Mr. Palmer, it was unanimously voted to grant the Special Permit as prayed for by the Petitioner for reduction of parking lot buffers from 20 feet to 7-10 feet as shown on the project development plans and without condition. No permit shall issue until 20 days from the filing of this decision with the Town Clerk. This decision must be recorded at the Registry of Deeds and a copy forwarded to the Board of Appeals. Appeals from this decision shall be made pursuant to MGL c40A section 17 and must be filed within 20 days after filing of this notice/decision with the Town Clerk. Unless otherwise provided herein, the Special Permit shall lapse if a substantial use thereof has not begun within 24 months. (See bylaw, MGL c40A §9) ttithw� 'f __. Steven UreYoung, Cha 2 Appeal #4312 COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF APPEALS Date: August 26, 2010 Certificate of Granting of a Special Permit (General Laws Chapter 40A, section 11) The Board of Appeals of the Town of Yarmouth Massachusetts hereby certifies that a Special Permit has been granted to: Town of Yarmouth 1146 Route 28 South Yarmouth, MA 02664 Affecting the rights of the owner with respect to land or buildings at, 383 North Main Street, SouthYarmouth, MA Zoning District: R40; Map & Lot#: 0100.01; Book & Page: 4738/242 and the said Board of Appeals further certifies that the decision attached hereto is a true and correct copy of its decision granting said Special Permit, and that copies of said decision, and of all plans referred to in the decision, have been filed. The Board of Appeals also calls to the attention of the owner or applicant that General Laws, Chapter 40A, Section 11 (last paragraph) and Section 13, provides that no Special Permit, or any extension, modification or renewal thereof, shall take effect until a copy of the decision bearing the certification of the Town Clerk that twenty (20) days have elapsed after the decision has been filed in the office of the Town Clerk and no appeal has been filed or that, if such appeal has been filed, that it has been dismissed or denied, is recorded in the Registry of Deeds for the county and district in which the land is located and indexed in the grantor index under the name of the owner of record or is recorded and noted on the owner's certificate of title. The fee for such recording or registering shall be paid by the owner or applicant. Steven NeYoung, C an TOW-N:O Y_ARA4- UTH • Town 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETT,S 026644451 Clerk Telephone (508) 398-2231 Ext. L285; Fax (508) 398,0836 CERTIFICATION OF TOWN CLERK I, Jane E. HibbeM Town Clerk, Town of Yarmouth, do hereby certify that 20 days have elapsed since the filing with me of the above Board of Appeals Decision #4312 and that no notice of appeal of said decision has been filed with me, or, if such appeal has been filed it has been dismissed or denied. BARNSTABLE REGISTRY OF DEEDS ARCHITECT CONSTRUCTION CONTROL AFFIDAVIT Project Name: New Lodge Building at Flax Pond Recreation Area Project Title: New Lodge Building at Flax Pond Project Location: 383 North Main St. S. Yarmouth MA Scope of Project: Construction of a new Lodge Building Architect Brown Lindquist Fenuccio & Raber Architects, Inc. In accordance with paragraph 116.0 of 780 CMR, the Massachusetts State Building Code, I, Richard P. Fenuccio Massachusetts Registration Number 7789 being a registered professional Architect hereby certify that all plans, computations and specifications, and changes thereto, Involving subject project will be prepared by or under the direct supervision of a Massachusetts registered architect or Massachusetts registered professional engineer and bear his or her original signature and seal or by the legally recognized professional performing the work, as defined by Massachusetts General Law (M.G.L.) c.112, §81R. For the above named project I, or a registered professional archilectlengineer under my cognizance, will review the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 1 will review and approve the quality control procedures for all code -required controlled materials. 1 further certify that I will be present on the construction site at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine, in general, if the work Is being performed in a manner consistent with the construction documents. Pursuant to 780 CMR 116.2.31 will provide the results of structural tests and Inspections to the building official and owner. I will submit, periodically, a progress report ' t comments of the site visas and compliance of all pertinent items to the building official. I wifts to the satisfactory completion and the readiness of the projectfo pan ,1LFE,t. Fo, • o A m. ,ry 8 No. 7789 W %+ U ��an' ZO/ 0 Arctfitect Ri hard P. Fenu VA Date Subscribed and Swom o, efore me is L_ ay c f �, 20Lv the undersigned notary public, personally apppeared C4 provide to me through satisfactory evidence of Identification, which is Gll/,S,ni r new d v I C_. , to be the person whose name is signed on the preceding or attached docume t, and acknowledged to me that he signed it voluntarily for its stated purpose. r Notary Palblic Notary PWft otary Commission Expires Alys 1kCMVftft ." BUILDING ENGINEERING RESOURCES. INC. REGISTERED ENGINEERING SERVICES CONSTRUCTION CONTROL AFFIDAVIT PROJECT NAME: New Lodge Building at Flax Pond Recreation Area PROJECT TITLE: New Lodge Building at Flax Pond PROJECT LOCATION: 383 North Main Street — South Yarmouth, Massachusetts SCOPE OF PROJECT: Construction of New Lodge Building In accordance with Section 1162.1 of the Massachusetts State Building Code, Seventh Edition, I, Steven A. Karon, PE, LEED AP, Mass. Registration No. 34989 being a Registered Professional Engineer hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL X . MECHANICAL _s FIRE PROTECTION . ELECTRICAL _, PLUMBING For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions for the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project I further certify that L or my Representative, shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the document approved for the Building Permit and shall be responsible for the following as specified in Section 1162 1. Review, for conformance to the design concept, shop drawing, samples, and other submittals which are submitted by the Contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all Code -required materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work, and to determine, in general, if the work is being performe in a manner consistent with the construction documents. . I further certify that upon completion of the construction, I shall submit a Final Report to the Local Building Inspector as to the satisfactory completion and readiness of the project for occupancy. Signature: Date: lolfflwo Expires: April 6, 2012 29 61 A I N STREET. BLDG. M 3 A NORTH E A S T O N. MA 0 2 3 3 5 6 D E S I G N I K N O W L E D G E I S O L U T I O N S STEVEN 0 NARAN MECHANICAL No. 34939 MMIN BUDDING ENGrNEERING RESOURCES, INc. REGISTERED ARGIRTECTURAL ENGINEERING SERVICES CONSTRUCTION CONTROL AFFIDAVIT PROJECT NAME: New Lodge Building at Flax Pond Recreation Area PROJECT TITLE: New Lodge Building at Flax Pond PROJECT LOCATION: 383 North Main Street — South Yarmouth, Massachusetts SCOPE OF PROJECT: Construction of New Lodge Building In accordance with Section 1162.1 of the Massachusetts State Building Code, Seventh Edition,1. Marc R. Plante, PE, Mass. Registration No. 38119 being a Registered Professional Engineer hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL FIRE PROTECTION X . ELECTRICAL PLUMBING For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions for the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project I further certify that I, or my Representative, shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the document approved for the Building Permit and shall be responsible for the following as specified in Section 1162 1. Review, for conformance to the design concept, shop drawing, samples, and other submittals which are submitted by the Contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all Code -required materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work, and to determine, in general, if the work is being perforrr a in a manner consistent with the construction documents. I further certify that upon completion of the construction, I shall submit a Final Report to the LocalBuilding Inspector as to the satisfactory completion and readiness of the project for occupancy. Signature: Date: /e/S//O Expires: April 6.2012 23 MAIN STREET, BLDG. a 3 A NORTH E A S T O N. MA 0 2 3 3 5 6 D E S I G N I K N O W L E D G E I S O L U T I O N S is MIN BURRING ENGINEERING RESOURCES. INC. REGISTERED ARCIRITECTURAL ENGINEERING SERVICES CONSTRUCTION CONTROL AFFIDAVIT PROJECT NAME: New Lodge Building at Flax Pond Recreation Area PROJECT TITLE: New Lodge Building at Flax Pond PROJECT LOCATION: 383 North Main Street — South Yarmouth, Massachusetts SCOPE OF PROJECT: Construction of New Lodge Building In accordance with Section 1162.1 of the Massachusetts State Building Code, Seventh Edition, I, Steven A. Karen, PE, LEED AP, Mass. Registration No. 34989 being a Registered Professional Engineer hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: ENTIRE PROJECT MECHANICAL X . PLUMBING :1 e1:11 URM _j FIRE PROTECTION STRUCTURAL ELECTRICAL For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions for the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project I further certify that I, or my Representative, shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the document approved for the Building Permit and shall be responsible for the following as specified in Section 1162 1. Review, for conformance to the design concept, shop drawing, samples, and other submittals which are submitted by the Contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all Code -required materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with *�t11 GF4:4,, the progress and quality of the work, and to determine, in general, if the work is being perform 'II' 5 STEVENA in a manner consistent with the construction documents. 3T NaRAN MECHANICAL I further certify that upon completion of the construction, I shall submit a Final Report to the LOW No. s+sse Building Inspector as to the satisfactory completion and readiness of the project for occupancy. �0 9FGlICTS SIONAL Etir'�e I Signature: Date: I U ZO sworn e/. 1,ctober 2010 i Ire r- 28 MAIN STREET, BLDC. e3A NORTH EASTON. RIA 023336 D E S I G N I K N O W L E D G E I S O L U T I O N S • * CONSTRUCTION CONTROL AFFIDAVIT PROJECTNUMBER: 1203-36 PROJECT TITLE: New Lodge Building at Flax Pond PROJECT LOCATION: Flax Pond Recreation Area. Yarmouth MA NAMEOF BUILDING: Lodge Building SCOPE OF PROJECT: 1-story wood frame construction and foundations In accordance with Section 116.0 of the Massachusetts State Building Code, Seventh Edition (MSBC), I, Brian A. Walsh, P.E., Massachusetts Registration No. 46077 being a licensed professional structural engineer, hereby certify that I (myself and/or my representatives) will be present on the construction site on a regular and periodic basis and perform the necessary professional structural engineering services as outlined in MBC 1162.2, to determine that the STRUCTURAL CONSTRUCTION WORK is, to the best of my knowledge and belief, in accordance with the documents approved for the building permit, for the following portions of construction: 1. Structural components as specified on Allen & Major Associates, Inc. structural drawings S0.1 through S5.3 2. Review of shop drawings, samples and other submittals of the contractor as required by the construction documents as submitted for building permit, and approval for conformance to the design, concept. I furthermore agree to submit periodically, an inspection report together with pertinent comments to the Town of Yarmouth building department. Upon satisfactory completion of the work I shall submit a final report certifying to the best of my knowledge and belief that the building structure is completed in general conformance with the referenced construction documents and the structural provisions of the MSBC. Work specifically not included in this Construction Control Affidavit to be provided by others shall include testing and inspection of materials in accordance with MBC Section 1703 for the following building components: 1. Geotechnical inspection and testing services (i.e. soil bearing capacity) 2. Materials testing services (i.e. concrete sampling and testing, bolted connections, welds, etc.) M Signature /' $ S1ItrJCT1lFiK a ft 77 Banat. Subscribed and swom to before me this 5 y of D� 0✓ 20 10. 9/1Sf ;L'0ji My Commission Expires On • 0 ARCHITECT CONSTRUCTION CONTROL AFFIDAVIT Project Name: New Lodge Building at Flax Pond Recreation Area Project Title: New Lodge Building at Flax Pond Project Location: 383 North Main St. S. Yarmouth, MA Scope of Project: Construction of a new Lodge Building Architect Brown Lindquist Fenuccio & Raber Architects, Inc. In accordance with paragraph 116.0 of 780 CMR, the Massachusetts State Building Code, I, Richard P. Fenuccio Massachusetts Registration Number 7789 being a registered professional Architect hereby certify that all plans, computations and specifications, and changes thereto, involving subject project will be prepared by or under the direct supervision of a Massachusetts registered architect or Massachusetts registered professional engineer and bear his or her original signature and seal or by the legally recognized professional performing the work, as defined by Massachusetts General Law (M.G.L) c. 112, §81R. For the above named project I, or a registered professional architectlengineer under my cognizance, will review the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. I will review and approve the quality control procedures for all code -required controlled materials. I further certify that I will be present on the construction site at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. Pursuant to 780 CMR 116.2.31 will provide the results of structural tests and inspections to the building official and owner. will submit, periodically, a progress report pertinent items to the building official. I vn� project f;9oocoupanW. „ Subscribed and which is and acknowledged to me No. 7789 • _ • • :ar+�rrrn MA comments of the site visits and compliance of all is to the satisfactory completion and the readiness of the jjk Jar. ¢, ZVI D Date of [,,L — 2010, the undersigned notary public, . provide to me through satisfactory evidence of identification, to be the person whose name is signed on the preceding or attached t voluntarily for its stated purpose. 3 •Iv •201-7 FS Notary Commission Expires BUILDING ENGINEERING REsouRCEs. INC. REGISTERED ENGINEERING SERVICES CONSTRUCTION CONTROL AFFIDAVIT PROJECT NAME: New Lodge Building at Flax Pond Recreation Area PROJECT TITLE: New Lodge Building at Flak Pond PROJECT LOCATION: 383 North Main Street — South Yarmouth, Massachusetts SCOPE OF PROJECT: Construction of New Lodge Building In accordance with Section 1161.1 of the Massachusetts State Building Code, Seventh Edition, 1, Steven A. Kann. PE, LEED AP, Mass. Registration No. 34989 being a Registered Professional Engineer hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: ENTIRE PROJECT X . MECHANICAL PLUMBING . IIGII�`i�i1 . FIRE PROTECTION STRUCTURAL ELECTRICAL For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions for the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. I further certify that I, or my Representative, shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the document approved for the Building Permit and shall be responsible for the following as specified in Section 116.2 1. Review, for conformance to the design concept, shop drawing, samples, and other submittals which are submitted by the Contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all Code -required materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work, and to determine, in general, if the work is being performe in a manner consistent with the construction documents. . I further certify that upon completion of the construction, I shall submit a Final Report to the Local Building Inspector as to the satisfactory completion and readiness of the project for occupancy. Signature: Expires: April 6, 2012 23 MAIN STR L E T, BLDG. a 3 A NOR T N E A S T O N. 141 A 0 2 3 3 S 6 D E S 1 0 N I K N 0 W L E D G E I S 0 L U T 1 0 N S STEVEN A\ KARAN MECHANICAL No. 34989 _ BuuDING ENGINEERING REsouRCEs. INC. REGISTERED ARr.HtMCTUR 4L AND ENGINEERING SERVICES CONSTRUCTION CONTROL AFFIDAVIT PROJECT NAME: New Lodge Building at Flax Pond Recreation Area PROJECT TITLE: New Lodge Building at Flax Pond PROJECT LOCATION: 383 North Main Street — South Yarmouth, Massachusetts SCOPE OF PROJECT: Construction of New Lodge Building In accordance with Section 1162.1 of the Massachusetts State Building Code, Seventh Edition, I, Mare R. Plante, PE, Mass. Registration No. 38119 being a Registered Professional Engineer hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL _1 MECHANICAL _j FIRE PROTECTION X . ELECTRICAL PLUMBING For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions for the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project I further certify that I, or my Representative, shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the document approved for the Building Permit and shall be responsible for the following as specified in Section 116 2 1. Review, for conformance to the design concept, shop drawing, samples, and other submittals which are submitted by the Contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all Code -required materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work, and to determine, in general, if the work is being perforrne in a manner consistent with the construction documents. I further certify that upon completion of the construction, I shall submit a Final Report to the Local Building Inspector as to the satisfactory completion and readiness of the project for occupancy. Signature: Date: �� S �0 Subsrn"andswomome this 'Jc1_ober 2010, mmission Expires: Aoril 6. 2012 28 MAIN STREET, BLDG. N 3 A NORTHE A S T O N. MA 0 2 3 3 5 6 D E S 1 G N I K N 0 W L E D G E I S 0 L U T 1 0 N S L%RC R PLANTE ELECTRICAL 140.313119 MININ BUnDING ENGINEERING RESOURCES. INC. REGISTERED ENGINEERING SERVICES CONSTRUCTION CONTROL AFFIDAVIT PROJECT NAME: New Lodge Building at Flax Pond Recreation Area PROJECT TITLE: New Lodge Building at Flax Pond PROJECT LOCATION: 383 North Main Street —South Yarmouth, Massachusetts SCOPE OF PROJECT: Construction of New Lodge Building In accordance with Section 116.2.1 of the Massachusetts State Building Code, Seventh Edition, I, Steven A. Kann, PE, LEED AP, Mass. Registration No. 34989 being a Registered Professional Engineer hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL _j FIRE PROTECTION . ELECTRICAL X . PLUMBING For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions for the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. I further certify that 1, or my Representative, shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the document approved for the Building Permit and shall be responsible for the following as specified in Section 116.2 1. Review, for conformance to the design concept, shop drawing, samples, and other submittals which are submitted by the Contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all Code -required materials. 3. Be present at intervals appropriate to the stage of construction to become generally fam the progress and quality of the work, and to determine, in general, if the work is being in a manner consistent with the construction documents. I further certify that upon completion of the construction, I shall submit a Final Report to the Local Building Inspector as to the satisfactory completion and readiness of the project for occupancy. r Signature: Date: Z(1 Subscri d sworn to a is `� ctober 201.0 00 Notary Pu Commission Expires: Aori16.2012 28 MAIN STR E ET, B LDG. 03A NORTH EASTON. atA 023356 D E S 1 0 N I K N 0 W L E D G E I S 0 L U T 1 0 N S /STEVEN A.\ KAAAN MECHANICAL No. 34999 _ CONSTRUCTION CONTROL AFFIDAVIT . PROJECT NUMBER- 1203-36 PROJECT TITLE: New Lodge Building at Flax Pond PROJECT LOCATION: Flax Pond Recreation Area, Yarmouth MA NAME OF BLUDING: Lodize Building SCOPE OF PROJECT: 1-story wood frame construction and foundations In accordance with Section 116.0 of the Massachusetts State Building Code, Seventh Edition (MSBC), L Brian A. Walsh, P.E., Massachusetts Registration No. 46077 being a licensed professional structural engineer, hereby certify that I (myself and/or my representatives) will be present on the construction site on a regular and periodic basis and perform the necessary professional structural engineering services as outlined in MBC 116.2.2, to determine that the STRUCTURAL CONSTRUCTION WORK is, to the best of my knowledge and belief, in accordance with the documents approved for the building permit, for the following portions of construction: 1. Structural components as specified on Allen & Major Associates, Inc. structural drawings SO.1 through S5.3 2. Review of shop drawings, samples and other submittals of the contractor as required by the construction documents as submitted for building permit, and approval for conformance to the design concept I furthermore agree to submit periodically, an inspection report together with pertinent comments to the Town of Yarmouth building department. Upon satisfactory completion of the work I shall submit a final report certifying to the best of my knowledge and belief that the building structure is completed in general conformance with the referenced construction documents and the structural provisions of the MSBC. Work specifically not included in this Construction Control Affidavit to be provided by others shall include testing and inspection of materials in accordance with MBC Section 1703 for the following building components: 1. Geotechnical inspection and testing services (i.e. soil bearing capacity) 2. Materials testing services (i.e. concrete sampling and testing, bolted connections, welds, etc.) Signature Subscribed and sworn to before me this 5 iUC of 20 IU, q�rslaol7 My Commission Expires On TOWN OF YARMOUTH BUILDING DEPARTMENT PLAN REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTES ADDRESS: Map / Lot: Date of initial Review: /D^ Other Review Dates: Inspector h Review Date: Approval Date: Permit Fee Calculations Correction List No. Description Code Section Zoning Denial (if applicable): Section 1043.2. para. Change, Extension or Alteration (preexisting, nonconforming) The proposed requires a Special Permit from the Zoning Board of Appeals. _Other Building Code Denial (if applicable) hy1nrv&b1d&penmu tier.3MM BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. Town of 1'arnunrth Building Departmrnt 1146 Route 28 • 1•armoinh. NfA 026644192 Tel: 508-398-2231 ext 1261 Fax 508-398-0836 i office use Only Permit No. I1 S Date Permit Fee $ Deposit Rec•d. $ 0Date Net Due $ Signature: Planning Baud Information Assessors Department Irdoroutlon: in Type IWo� � � Lot dorsement Date cording Date New No. 1.4 Property Dimensions: Lot Area IV) Fronnge (tt) lot Coverage auu.�y vnxaer Daft / `.--(,L Is not rpWreid Section 1 - Site Intormatlon 1.1, eety PPropAdd fit - 12 Zoning Information: n� /— Zoning District Proposed Use t.a ewtatne Setbacks Ittt Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided v - � 1 1�bo � ManillgAddrei7:� rti o of of i 181 R s3 9a Signa Telephone Fax Secton 3 - C nstntctlon Services Not Applicable License Number CS TO 2-f Expiration D 3 P-12ol/ tote nVFR 3.2 Registered omiivants Name Address Signature Telephone Not Applicable Registratbn Number Dam Section A. WorkerS'COMVerl3atlOn Insurance Affidavit (M.G.1- c. 152 s 25C (D) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure Workers provide this affidavit will result in the denial of the issuance of the building permit. Affidavit Attached Yes .......... No .......... Section 5 - Professional Design and Construction Services - for Buildings and Strictures Subject to Construction Control Pursuant to 780 CMR 116 (containing more than 35,000 c f. of enclosed space) 5.1 Nof Applicable Marna 1Mfrnumdt+ Rsystraw n Number Address Eurpaatbn DM Signs lt� Telephone Section 5.2 Reg Istered F'roresstortaf r=n nrwr ar Are of Respo,siweY Nam" Reyabatlon Number Address Sig.w Telephone Elpireeon Dan Ama of Remparm tY Name Reglabatlor Nt~ Address Telephone Espirohm Date AM of Respanbuh Nana peosinMon Number Address Signatxe Telephone Espaatbrr Den Ana of Fl VMbMY Mare Re"nitbn Nunbsr Address Signature Telephone Espaatbn Dan Section 5.3 General Contractor WAppkable ❑ conve" Name • _. . Person ResPonstble for construction _ .. Address Signature Telephone ._ 2of 4 i. tectlon 8 - Description of Proposed Work (I neck a sppeubls) New Canstrucdon ❑ I (ror mu Pm famltv alb) No. of Bedrooms (for mum* famk mM Nm of Bathroom Eahtinp 9lft (3 1 Repalge) ❑ 1 Alterations ❑ 1 AddGon ❑ Accessory Bldg. ❑ Type Demolition Other Spedf�r. Brief Description of Proposed Work 8uttdinp Use Group (Cheek s apPkqpd)k) Cooah talon Type A ASSEY0.Y ❑ A-1 ❑ M E3 A,2 ❑ AOL1,0000 A4 Q to to ❑ ❑ a suswcss ❑ 2A 20 2C ❑ ❑ ❑ E EMXATKP" ❑ F FACTORY. ❑ F-1 F-0 M MKI14HAZARD ❑ 3A ❑ ❑ 1 MCTIMIONAL ❑ 1.1 4a m R mvcK l[ ❑ A(3! • ❑ . R REscEmnAL ❑ R-1 wz SAs STOIM 11 ❑ 5-1❑ 3-21 aso u MUM ❑ spoor. SPEC".. arer.Irr. M ACTED USE ❑ I s SPECML use ❑ t:ahsngun OraeK EAm2m lhard bider Teo CMR 34 Muff6wal cows w slor4e Total atldalarts and/or chanp In re Prepoeed Use OIap: Proposed Chard kdu Tao CMR Section 9 -STRUCTURAL PEER REVIEW 7& CMR 11011 Indepwldera Str cl ral EnOww" SMCKFW Pow RIL 0 Re*kW Y" ..._..... No SECTION 10a OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWN S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. 151-444 , as Owner of the subject propeAyt hereby authorize C Q, to act on my behalf. In al mattes relative to work augxxted by this buikdng permil application. W /a S19nallre oww ��—Oahe 3of• OVER i c i —jaws arr //w v . as Owner/Authorized Agent hereby declare that the statements and tnfom+ation on the forgoing appacatlon are true and acurate, to the best of my, knowledge and belle(. Signed Linder (the f ]pains and penalties " of pert%ury. I_r��-K t/—'//USa/`��J%%�117 / � L✓N vT jS��l/ Pf" N&M • d OwrNgAgradam I Check Below I ❑ Commu to W mrN lion FMV (11 applicable) ❑ OId lanya l r4iw y & Hblork�l (e applicable) 4 or 4 The Commonwealth ojMassaehusetis Department ojlndrrstrlal Aedldents Office ojlnvadgadons 600 Washington Street Boston, MA 02111 www..-. sSuv/dam Workers' Compensation Insurance Affidavit: Builders/Con DUcant Inrmation tractors/Electriclans/Plumbers fo Name Ul /State/zi UUD✓Sc1Ll--o j IMA 0IS6I Phone Are you an employer? Check the appropriate box: l.0 I am a employer with 4. 1 am a general contractor and I t9 employees (Aril and/or part-time).• 2.0 I am a sole have hired the gob contractor listed proprietor or partner- ship and have no employees on the attached ghat These sub -Contractors have working for me in any capacity. employees and have workers• [No worker' comp. insurance comp. insmance,t requued.j 3.0 1 am a homeowner doing S. 0 We are a corporation and its have all work • Officers exercised their myself. [No workers' comp. right of exemption Per MOL 32.0invurancIhome ] acting as a c. 1'2, 11(4), and we have no general contractor (refer to #4) employees. [No worker' comp, inan.n.e •613a Type of project (required): 6. RNewcomtruction 7. Remodeling 8. Demolition 9. 0 Building addition 10.13Electrical repairs or additions 11.0 Phtmbing repair or additions 12.0 Roof repair 13.0 Other 'Any appUmse do Cheeb boa al mou am all. the section below showing Heir wmkns j polky inihmod Homeowmr who submit this aRldtvit Mcsting 6" me doing as watt and rhea him ou m tconesemn then check this boa must&mwhw soad&dmw sheet COnaaetnr 0n st submit a sew amldavit iaaieating vetch. If the at6-wevaeaws have sag the cams orthe sobemnsetoa and sew wbmhw or out thor —9 hove amOoYKe, tom' tom povide their worker' Comp• Policy comber. lnjormadotn Y`rover u prurroata wortterg' companadon brsareneejor ary employees Below Lr the _ _ Pt>&7a+tdJobstar Insurance Company Policy # Expiration Date: Job Site caa. .ir1j. MINI City/Statemp: Attack t copy of the workers' eompematba policy declare on page (showing the policy number and expiration date). fineup to secure coverage 0 required under Section m of MOL c. 132 an lead to the fine up to S I,S00.00 and/or one-year imprisonment, as well as civil imposition of criminal penalties of a of up to $250.00 a day a the violator. Be advised that a Penalties in the form of a STOP WORK ORDER and a fine Investigations of the D fo coPY of this statement may be forwarded to the otAa of nsurancJt.rtovmgevcrification. /do the Ofj?efo/ ask oah Do not write k tblr ern, ar be comp4ard by c4 or Maw offWal Arsd eorreet City or Town: Permittucense 0 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. ChYfrown Clerk 4. E 6.Other lertieal inspector S. Plumbing Inspector Contact Peron: Phone N• s• .+ r Information and Instructions M,,,,a�t,a pcmral Laws chapter 152 m4pdM all employdn b Pro" a10 O° Wr OGU d b M ptnsuad to dds Slugula. �ln ter d de - ara� pesos III rite ra.+c. of soother Hader ear c�sorbit.. OVM or IvWH4 col or wriftee b detised se -ta �� co+P°taii0s at other kepi atity. at � two er woes M ay1?ar a and is ht dr kepi tepeaatadra Ora doceaaed employes; is - d ep , associsdos or O&W Igo entity. w9bl� mpby"& Hd11A� Ihs owner ors dwvM* house ba ft ad must deal Hasa Wat�sata and wbe reside t np@k.� am � ft � dw.0 6 how orssoteer wbe employs puma to do mafaemaaa, coasttattbs or � deemd la be s employe' a as the t� or building aPP�t �tO shall not beaw of Sack aapbyo MOT. eheplae 15% J25gd) an sdtea dog '@-a4 seta K iatat tira"daL ag � � wfthMM 4taava M r"wwd d a vasaa K parmlt t. opsnta • coda.. a b eesrtrret lsdYap amplablea.ld.vea.rt.Srupm s wkktf.lsyaa.aa icas r.gsk+d a AdifitIONSON MCL �� js� em+"Nehhs des eO®o� Oar aaf atilt political with doiona shall ester fob dry eonhaet flay d» par�nseca of Pobib wod<wd! aceephbls evideaa of with Ihs fnaerseee Cegdmum s orlbla ebaplet bars bees peaeaed b drf eao+aedai " Flaw as out tits worI= amdavit ebb. by -hoc ns tits boa. thal .pply to yw a Ifnscmwy. mpply �-aO°racla(s) aama(e). dd�aS(a) and phase a>mba(a) sioni wig oo bysa other &M the ioauSana Ltmibd Lkbilky Campaaba (Lu7 a Limibd Liability paeta� (Lu) as not e� lemf warluo• gcqoke& Be sdvisod dot this affidevit my be fsneaaa Ira LLC or LLT dad have twobw brdo DvPWftW Of TO&NUM POHCY is dOs of 8oaafaeeo eo�aade � zlP db too altiiark. TIN d d"it Should AccidCONS beg b rho city a low. teal tits applicatim titr the P� or Hainaut Is being Segnsels%.sl tit. D.pertmat o[ Sboald ytt I have uy qna e* =Wbp� the law ar itym sm cpuleed inobtai ■ woeloats• industrial AWWROIL eao listed belo poibf. pleat all tee Dep wbnM Sl the mmbsr w Sd>rtnaerod >paeiaa Should ewer recur City sr T.ws Omdab Please b. sere dot Eta affidavit is tompiew and Risad biihty. Time Depanoeet has peovided a specs d tea boom or tit. atls8svit cis yos b tm out in tb...e d th.Oma Orbavesdpdaea bat to tourer yea eepe " dWaPPiieans pteaae t sere b 7 to tit@ paadtllfaa...amber width will bo used u a costae. ®bat: is addida4 s POC do moat submit maefple PWMWIOO" appdad' is nay ii*es veer, deed Defy SObmk use at'lldsrit 6>diatlos eoaent (if am and ust -lob dlr Addts:ae" tits appBeset shoold wdo %9locations be (City or town}- A COPY ortee at15dsvit that ba been oMdWly ttnWW or watind by dw city or laws my be p,ovidad 1060 applieesl m pros obi a valid amBevY is a tits fhr cites. Pwwim ar Hamm A nrw amdarft Hart be tBlad net tack yes Wbas a home owner a cidna is obtdda f a BMW ar pawk not nWd b asy buthr.s at Co®aCW venwe (Le. s dos Basso or permit is buss ea term ) said pesos is NOT requited is con ir" chit &M&viL The OIAa d tavadpdoea would Mew &mk ym is advance lor yes Coopaatios sod Should yea bave any qur.tiona. please der act baihb is tk• a a all. [lr Deprmsut'a addMM trkpbo= ad da mmubus Tha Commonwealth or Musectrusetts Department of Industrial Accidents Offla or Iti T"Ptions 600 waehinOon street Boston, MA 021 It Tel. N 617.7214900 ezt 406 or I477-MA93AFE Fa 0 617-727-7749 pavised 11.22-06 www.rnosLpv/dI& 3e° "sc TOWN OF YARMOUTH = BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FOR PLEASE PRIM: Job Location: �3�3 •i�4tQ d1 n�o. l/Irl4 Owner of Property: I o •"x Construction Supervisor. M2yxs T(4*-%-j CS7g52. No. Address: 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 Anylicenseewho 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: 1 have a current liability, Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ No ❑ If you have checked yu, please Indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 152 of the MGeneral Laws, and that my signature on this permit application waives this requirement !!!/ \1 i � Check one: of Owner ❑ Agent ❑ Signature: Building Official Approval: TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1113, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at Work Address Is to be disposed of at the following location: ✓L 0.<, Said disposal site shall be a licensed solid waste facility as defined by M.G.L. of Permit No. bZ D to TOWN OF YARMOUTH Building Department Town Hal Yarmouth. MA 02664 (508) 398-2231 ext1261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-11-194 Applicant Name: Dennis Mason Applicant Phone: 7819539012 Building Location: 0383 NORTH MAIN ST Owner's Name: TOWN OF YARMOUTH Owner's Addres 1146 Route 28 South Yarmouth MA 02664 Owner's Telephone: (508) 398-2231 ' REVIEWED BY: (OFFICE USE ONLY Recorded By. IC Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 11/2/2010 Issue Date: Expiration Date Comments: Map/Lot: 100.1 foundation only - Approval In Part as per 780 CMR Section 5111.13 ZONING APPROVED 1. WATER DEPARTMENT: DATE: WA: 2. ENGINEERING DEPARTMENT: DATE: WA: 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: DATE: WA: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 11/2/2010 FA��y_ CERTIFICATE OF LIABILITY INSURANCE % n, nAM81 o De3anctis Insurance Agoy, Inc. 36 Cummings Park Woburn NA 01801 Phone:781-935-8480 =ax:781-933-5645 17 sells8trttrrn�ceat, 14"i1 Woburn NA O18o1 INSURERS AFFORDING COVERAGE L INSURER 0. THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ARM FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN a SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CCNDMONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS LYN Me" TYPE OF INSURANCE I •• POLEYNUMOER ! MM Dm TE NNIO Lam ORN104LLaeL11Y EACH OCCURRENCE 82,000,000 A IE tBAaEACNLOENERALLIASILITY, CPA011332316 04/01/10 _ 04/01/31 rwEMiREe E.DAtYaPVRA s250 000 CLAMS MAIXE X�OCCUR MEDEXPWV"PM ? s15000 sl 000 000 B : X Pollution ECC10200641201 04/01/10 04/01/11 PERSONAL a ADv KAM s2 000 000 _ cENlRALAGGREGATE ' OENLAOUREOILTE APPLIES PER IIC ►ROOTS.Cowx PAOO s2 000,000 PLRIMpI.T POLLYIE 79 LOC Pollution Sail 3 mil AUTOMOBILE LIABILITY COLBSED SINGLE LRJR $1,000,000 ANYAUro , R,�I ROOI.Y "LAMP ALL OWIEDAUTOS s A S SCREDULEDAUTO$ MA011332416 04/01/10' 04/01/21 PwIM~j Z HIRED AUTDS BODILY AIRY H '7C NON-0WNEO AUTOS PR PROP s 2ARAGELIAB6RY AVTOONLY.EAACCMM I OTHER THAN EAACC 11 .... .. AMYAUTO AUTO ONLY: AG S EXCESSVMBRELLA Ll11lILRY EACH OCCURRENCE B1O 000 ODO AI OCCUR nMAMSMADE CUA011332716 04/OS/10 04/Ol/11;AmREaTc $10 000 000 j t DEDUCTIBLE. 1} I RETENTION S B WORNSRS COMPENSATION AND R TO. S ER _ A DRPLorRRSLIAearrr WCA011332817 04/01/10 04/01/11 ELNICHACCRENT 1500.000 ANY PR"ETOIWARTMER ERECUPA OFT�FICER&KMKR EXCLWEOT D91 � •• EL pSMI.G 6500000 �soMAL P"O .10MS pW I ,EL DISEASE. POLICY LIMIT 6500 000 1 OTHER DESCIDPTON OF OPERATIONS I LOrATO/a IVEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROMSOMS Evidenoe of insurance CFRTIFICATF Nnl nFR CANCELLATION EV=Z-1 SHOULD ANY OFTHEABOVEDESCRIBED POLICIES BECANCELLEDBEFORE THE EXPIRATION DATBTNEREOF.7HEIBBUN4NSVRERWLLENOEAYORTOMAIL 30 DAYS MST= NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LER, BUT FAILURE TO DO BO SHALL EVIDENCE Or XNSOAASTCE IMPOSE NOOBLIGA710N OR LIABILITY OF ANY KIND UPON THE INSURER ITS ADENTS OR Board of Building Rrwlations and Standards ' Construction Supervisor License f License: CS U&N Restricted to: 00 i . 1 DENNIS L MASON 2 ` PO BOX 462 f DENNIS. MA02638 1 i i i Expiration: MAW ('onn.hirrr Trs: 13470 1 , • YARMOUTH FIRE & RESCUE Commercial Building Permit Sign Off Project Name:Flax Pond Project Address:383 North Main St. S. Yarmouth Contact Name:Pat Armstrong Phone #X-1520 Y NO NA Subject Regulation E S Access for Fire Apparatus 527 CMR 25.02 Building Numbers MGL Chapter 148 sec 59 'Flammable gat/liquid storage 527 CMR 14.03 Fire Lanes 527 CMR 10.03(10) *Service Stations 527 CMR 5 & 9 *Hazardous Materials Storage 527 CMR 25.08 'Kitchen Exhaust Systems 780 CMR. 527 CMR 10.03(8) Extinguishers 527 CMR 10.02, Chapter 148 sec 28 'Fire Alarm Systems/CO detection 780 CMR. Chapter 148,527 CMR 24,CMR 31 *LPG Storage Chapter 148 sec 9,10.28 & 527 CMR 6 Pesticide Storage 527 CMR 37 *sprinkler systems 780 CMR & Chapter 148 sec 26 A-1 Storage inside/outside Buildings 527 CMR 10.03(5) *Vpholstery 527 CMR 29 'Trash Containers 527 CMR 10.04 & 34 Any Hazard to the Public Chapter 148 sec 28 'Curtains Draperies, Blinds 527 CMR 21 Description of planned project/other requirements: Constructing new recreation building. Planned revied at site plan and fire alarm system is required. •YFD permit required -depending on occupancy and submittal Plan Reviewed By: LL Jon Sawyer Date: 11/2/10 Copy for Applicant® Copy to Building Dept.® Copy to Fire Prevention 19 TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 - Fax: (508) 771-7998 Letter of Water Availability Date of Issue: 11-1-2010 1. Single Family Dwelling 4. Commercial / Industrial X 2. Duplex Family Dwelling 5. Other (Specify) 3. Condominium Dwelling Reference; Massachusetts General Laws Chapter 40, Section 54 To: Town of Yarmouth Building Inspector Please be advised that the Town of Yarmouth public water supply is available to service lot / Parcel (s) 1 Street: 383 NORTH MAIN ST SY As shown of Assessors sheet / map 100 Issuance of this Letter of Availability is subject to the following provisions / restrictions: (1) The property owner agrees to comply with all federal State, and Local Laws, Rules and Regulations as they pertain to the use of the public water supply. (2) The Yarmouth Water Department shall have exclusive rights as to the size, number, type and location of all water service lines, fire service lines or appurtenant Items connected to the water distribution system. (3) The Yarmouth Water Department reserves the right to require, at the property owner's expense, the Installation of water mains and appurtenant items to meet water demands requisites within any structure relevant to this Letter of Availability. (4) This Letter of Availability will expire 180 days from the date of issue I have read and understand the provisions / restrictions of this Letter of Water Availability. er (sign) AwYarmouth Water Department %0 R ARD t IF TOWN OF YARMOUTH til{IYCI.11.N IIOIR(it 11.2S No III :�u�(-1n .L-ti,.\t.Ifl1I rItiw-,l0 l.u'.o_, Ivk-ph,u,,- IVN-C^_al. [xi.'271.2;n — ICI\ 00.1�) S!iv-_, 6.7, AllN18'fR:\T()R FILE C0PRY,.'4 :.l.11%,loll.,,. MEMORANDUM Alay 21, 2010 3-63 /vorL.-TH Fi/1-!ni S� TO: Board of State lixaminers of Plumbers and Gaslitters FROM: Pcter Johnson -Staub, Assistant'l'own .\dministrator SUBJECT: Plumbing; Variance Our statement of hardship did not fit in the space on the form and is thus provided below in its entirety. The variance request will be to deviate from 248 CAIR 10.02 (6) (b) Principle #G "11equired Plumbing Fixtures" on page 82 and 248 CAIR 10.10 (18) "Alinimum I-acilitics for Building Occupancy Other than Residential" on page 248CAIR-152. The Town of Yarmouth has run a summer activities program for children at I lax Pond for decades. 'lhe program is relied upon by families to provide safe, fun, affordable care for children during the summer months. The building in question is one of five in a campus style complex which was originally built as a private camp in the 1960s and was not built to today's code. The main building that is to be replaced does not have any bathrooms. It is in very poor condition and needs to be replaced and the Town has obtained a reimbursement grant for $500,000 to offset a portion of the cost. Our architect estimates the total cost to be about $1.4 million but we have only $1 million in funds including the grant reimbursement. The grant requires that the funds be spent by Junc 2011 to qualify for reimbursement. As we do not have sufficient finds to construct the entire building this fall, our plan is to construct the building in phases. Although the'Town's strong preference was to include the bathrooms in the first phase of the project, we cannot meet budget for the basic structure without removing the more costly space. 'lhe section of the building including the bathrooms will need to be deferred in order to make budget for the project. 'lhe Town does not presently have funds to complete any portion of this project without grants and private donations. We seek a variance so that we can obtain a building permit to construct the first phase of the project. We reeognve the bathrooms are needed and they will be constructed as soon as funds become available. We have plans prepared for Phase 2 of this project including bathrooms in full compliance with building occupancy. We are in the process of soliciting private funds and grants to Complete the second phase of the project which will include the bathrxnns.'lltc Town is committed to completing Phase 2 within 3 years. 'Ihe existing building to be replaced does not have bathrooms. The bathrooms are located in another freestanding restrxom building located less than 100 feet from the proposed stricture. 'Ihc adjacent building has 3 Alen's Fixtures (2 toilets, I Urinal) with 2 sinks and 3 \\'omen's Toilets with 2 sinks, which meets and exceeds the combined occupancy of the main building (subject of this variance) and the building containing the restrox)ms as well as the overall minimum fixture requirements for the entire park as a "public beach" facility. '11iis project is the first step in replacing dilapidated structures that do not meet code with new .structures that meet all axle requirements. the only reason we are requesting this waiver is because we have a timeline driven by the grant. If we do not award a construction contract by October 2010 with funds in hand at that time, we will not qualify for the }grant and the entire project will have to be cancelled. If the project is eanccllcd, the town will be forced to forfeit the }grant and keep the current nun -conforming assembly/administration building which, as mentioned, does not have any plumbing facilities. 'lltank you for your consideration. cc: Leon I tall, Alternate Plumbing Inspector Jamcs Brandolini, Building Commissioner //P:\RFCRI A'I1ON\I4rs Pond Improvemcnte\Plumbing va iance.dou FILE COPY ■■N■ BROWN LINDQUIST FENUCCIO & RABER ARCHITECTS, INC. 11 January 2011 Mr. James Brandolini, Building Commissioner Yarmouth Town Hall 1146 Route 28 South Yarmouth, MA 02664 RE: Construction Control Progress Report No. 2 New Lodge Building @ Flax Pond Yarmouth, MA Dear Mr. Brandolini: �U JAN 19 2011 WILD!= DEPr Since our last Construction Control Progress Report in mid -November, we have conducted several site visits to monitor the construction work and adherence to our construction documents for the subject project. As of this date, the following general work has been completed: ➢ Underslab plumbing and electrical rough work had been completed, backfilled and compacted ➢ The interior concrete slab with perimeter insulation has been installed. Although originally constructed incorrectly, the contractor has corrected the slab edge detail for the proper code - required thermal break. D Rough framing is nearing completion. ➢ The roof sheathing along with roof shingles have been installed ➢ Rough plumbing has been completed and inspected by the town D Rough electrical and mechanical work is nearing completion Windows are expected to be on site and installed in about a week. The work completed to date by Seaver Construction, Inc., and their subcontractors, has been completed in a good and workmanlike manner, and in general conformance with the drawings & specifications. All required town inspections for work completed to date have been completed. The structural engineer of record has visited the site twice to inspect tie -downs and anchoring hardware per design. (See attached reports). Please find attached construction progress photos and the structural report. 203 WILLOW STREET.SUI7E A PH 508-362-8382 VARMOUTHPORT.MA 02675 WWW.CAPEARCHITECTS.COM FAX 508-362-2828 If you have any questions, please feel free to contact me at anytime. Sincerely, Richard Fenuccio, Principal-m-Charge le. CC: Jim Lefler (Yarmouth DPW) Bill Caci (Seaver Construction) Dennis Mason (Seaver Construction) Tim Sawyer (BLF&R Architects), Project Manager AK AkAk ALIEN & MAJOR ASSOCIATES, INC. 100 Commerce Way P.O. Box 2118 Field Report #1 TcL- (n MA01880118 Tel• 781) 935-6889 Fax: (781) 935-2896 Client: BUR Report Date: November 23, 2010 Project: Flax Pond Recreation Area A&M Project #: 1203-36 Location: Yarmouth, MA Contractor. Seaver Construction Weather. Clear Temperature: 50 Date of Site Visit TNovember 19, 2010 Time: From: 10:00 am To: 11:00 am Present at Site: Tan Sawyer (BLFR) Brian Walsh (A&M) Reported by: Brian Walsh The following Items from previous reports are outstanding or resolved as indicated: None. The following was noted: 1.1 Observed foundation wall formed In place and In the process of being backftlled. Foundationtfooting geometry is consistent with the design documents. 1.2 518" diameter general stud wall anchor bolts are cast in place at 48" centers. 1.3 Cast -in holdown anchorage for the HDU5 and HDU8 holdowns are not in the stem wall per schedule on A/S0.4. These anchorages will need to be drilled and set in Simpson AT adhesive. All anchors should be drilled, cleaned and installed in accordance with adhesive manufacturer's recommendations. All drill holes must be cleaned with a wire brush and compressed air. Drill depths provided here account for the reduced wall section at slab shelf and should be measured from top of foundation wall. Please notify BLFR/A&M in advance of drilling so that confirmation can be made of anchorage depth and preparation. Written report from testing company, and/or observation by BLFR/A&M, and/or photographic documentation will be required for drilled anchorages of HDU8's. 1.3.1 HDU8 holdowns, 7/8' rod,1' drill hole, 24' deep 1.3.2 HDU5 holdowns, 518" rod, I I/16" drill hole,18' deep. civil & structural enginecrs • land surveyors • environmental consultants • landscape =Wtccts www.aIIcru=jorcom 1.3.3 HDU2 and HDU4 perA/S0.4. 1 A Perimeter deck pier footings are observed in place and backfilled. 1.5 Except as specifically noted herein, the work is observed to be progressing In accordance with the structural design documents. 1.6 The next structural observation by A&M is required after rough frame of the structure; but prior to application or roofing materials. Ideally all framing hardware W11 be installed at this observation. The above items were reviewed with the project superintendent prior to my departure from the site. 1� /a 115 LX Brian A Walsh, P. Sbuetural Department Manager Emal: BWalsh9b11enmaior.com 0 Paae 2 AL ALAL ALIEN & MAJOR ASSOCIATES, INC. 100 Commerce Way P.O. Box 2118 Field Report #2 Tch (78 MAU1888-0118 TeL• (781) 935.6889 Fax: (781) 935-2896 Client: BLFR Report Date: December23, 2010 Project Flax Pond Recreation Area A&M Project M 1203-36 Location: Yarmouth, MA Contractor: Seaver Construction Weather. Cloudy/Light Rain Temperature: 40 Date of Site Visit December 21, 2010 Time: From: 1230 pm To: 200 pm Present at Site: Tim Sawyer (BLFR) Dennis Mason (Seaver) Kevin Poore (A&M) Reported by: Brian Walsh The following Items from previous reports are outstanding or resolved as Indicated: 1.3 Cast -in holdown anchorage for the HDU5 and HDU8 holdowns are not in the stem wall per schedule on AlS0.4. These anchorages will need to be drilled and set In Simpson AT adhesive. All anchors should be drilled, cleaned and installed In accordance with adhesive manufacturer's recommendations. All drill holes must be cleaned with a wire brush and compressed air. Drill depths provided here account for the reduced wall section at slab shelf and should be measured from top of foundation wall. Please notify BLFR/A&M in advance of dulling so that confirmation can be made of anchorage depth and preparation. Written report from testing company, and/or observation by BLFR/A&M, and/or photographic documentation will be required for drilled anchorages of HDU8's. 1.3.1 HDU8 holdowns, 7/8" rod,1' drill hole, 24' deep 1.3.2 HDU5 holdowns, 5/8' rod, 11/16'drill hole, l8' deep. 1.3.3 HDU2 and HD114 per NS0.4. [12-21-101. Adhesive anchors had not been Installed as of this observation. Additional Information regarding holdown and anchorage placement was included In a sketch sent to T. Sawyer on 12WO10 and was discussed with D. Mason prior to my leaving the site. civil & structural engineers • land surveyors • environmental consultants • landscape architects www.allenmajorcom The following was noted: 2.1 The purpose of the visit was to observe the overall building framing and hardware. 2.2 Observed typical eave bk)ddng and perimeter bearing conditions installed in accordance with the structural design documents. 2.3 Observed rake overhang bloddrg installed to accordance with the structural design documents. 2.4 Observed ridge beam and hangers at conventional framed roof. Ridge straps had not been installed at the time of this observation. D. Mason stated that they would be installed prior to roofing materials being placed. Pictures of this item will be forwarded to A&M confirming proper installation when completed. 2.5 Observed drag truss at interface with conventional roof to have plywood spacers placed and ready to receive sheathing to be placed between the drag truss and the stud wail. Sheathing will be placed to the underside of the sloped roof sheathing within the Omits of the shear walls along this line. The diagonals of the drag truss are to be nailed to the Intersecting studs through the sheathing once in place. 2.6 Typical gable end bracing was not Installed fully at the time of this observation. D. Mason stated that the additional blocking at the roof level would be installed prior to roofing materials being placed. Pictures of this item will be forwarded to A&M confining proper Installation when completed. 2.7 Required 31160)Q'x2' plate washers were not observed. In follow up phone call on 12%12/2010 to D. Mason, he confirmed that they would be installed within the Omits of all shear walls. 2.8 Column bracing for the two full height PSL columns on the gable end (grid One 1) require an alternate bracing detail to the one shown in detail WS5.1 as the columns were cut off below the top plate and not extended to the underside of the roof sheathing. An alternate detail will be coordinated and Issued as an SK 2.9 Except as specifically noted herein, the work is observed to be progressing in accordance with the structural design documents. The above items were reviewed with the project superintendent prior to my departure from the site. ti4(. vin Poore Project Engineer Email: KDaore@atlenmaior corn 0 Paw It - I 'j .- �:l a� jAf��s•stiiu �•1�" �j��� o•Im11. = #a�L y _: ii >.ii . , 1 INA bW) an I I I A .+ . 77' APw _T4 it F ri a Y, pe AM . _.. .1� ': ',. 5,.., t ,'' .,i__. _. ____.__.._ _ ____________._.._. t r! f r J rl 9 t ¢f'e 'v z G �f • • a t DEVAL L PATRICK GOVERNOR TIMOTHY P. MURRAY LEUTENIUR GOVERNOR GREGORY BIALECKI SECRETARY OF HOUSING AND ECONOMIC DEVELOPMENT July 29, 2010 gz�b, WE BARBARA ANTHONY Commonwealth of Massachusetts UNDERSECRETARY. OFMEOF Division of Professional Licensure `°""'ME"`A REGuLATION '"�" M & Board of State Examiners of Plumbers and Gas Fitters GEORGE K. WEBER N OF 1000 Washington Street —Suite 710 • Boston • Massachusetts • 02118-6100 rRess�L ON•° UCINSURE Assistant Town Administrator Attention: Peter J. Staub 1146 Route 28 S 0, Y th, MA 92664 F'-c civr rcRIN Or Yq I. AUG — 4 P010 ou annou 3$3 TOVrN A.p•• ., - , 7.'IO2 Re: Variance Granted — Flax Pond Park — North Main Street — South Yarmouth Dear Mr. Staub: Please be advised on July 28, 2010 in the Board Meeting Room, 1000 Washington Street in Boston Massachusetts, the Board of the State Examiners of Plumbers and Gas Fitters deliberated on and voted unanimously to Grant a variance from 248 CMR 10.10 (18) Table 1, with conditions as follows: 1. The Phase one (1) project will not include the installation of toilet facilities. 2. The Phase two (2) project will include the installation of toilet facilities in conformance with 248 CMR 3. The phase one and two projects are to be completed within three (3) years. This variance is based solely on the presentation, information and documentation submitted in the application by the Petitioner and is applicable to this site only. All other plumbing and gas fitting work if applicable shall comply with the rules and regulations of 248 CMR 3.00 through 10.00 and all other applicable statutes and codes. Sincerely, For the Board, J eph A. Peluso, Jr., ecutive Director The Board of the State Examiners of Plumbers and GasStters cc: Leon Hall Plumbing and Gas Inspector IMPORTANT NOTICE TO APPLICANTS A COPY OF THE BOARD APPROVAL FOR THIS REQUEST, IF GRANTED MUST BE FILED BY THE APPLICANT WITH THE LOACAL BOARD OF HEALTH, IF APPLICABLE, AND THE LOCAL PLUMBING AND/OR GAS FITTING INSPECTOR BEFORE THE START OF ANY PLUMBING OR GAS FITTING WORK. TEL 617-727-9952 FAX: 617-727-6095 TTYrrDD: 617.727.2099 httpJhvww mass.govldpVboardslpl �t •YqR F TOWN OF YARMOUTH BUILDING DEPARTiNIEN•r 1146 Route 28, South Yarmouth, iNIA 02664 508-398-2231 ext. 261 Fax $09-398.11836 Permit Number---1 I- 1Z Date Issued Expiration Date $50.00 TRENCH PERMIT Pursuant to C.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION NameatApplleara 7o-WN G eL 4Q,*wV)C Phone Call S ap9.�d-N-�9t1-aNY/ ClryRown NA ZIP Nam of Excavator Uf different from applicant) Phone CCU Street Address ( E IL l'fty/1'swn 17W Name of Owner m) of Property wW N O F pmx" Cell SlredAddress n3 /J044 RTr4:.0 ST• LPo-up u 2 CRffrown Sa YA01.,uo MA ZIP . 0 • Other Contact Permit Fee Retched No Ya Description, location and purpon of propeud beacht Please describe the exact location of the proposed trench sad Its purpose (Include a description of what Is for Is Intended) to be Idd In proposed trench lea: plpedcable Nam etc-) Please ase reverse side If additional space is needed. %4G X parucr )Zcc�.t 4-ioNv A�A :tYa'D' T(l,(.wCN Foy- z4cearK./c Seierlct•.xfi' ccMMuA)le-,InA CA151II.5 50 Pipcs YD 2;4 6NCN5,CD*1*,0 e0vuCftr-TE + L(00'TIz,ENGNEi To tNSTAze- fv •" D0l?t4tivA6X PfPdt insurance s.enmcaa ai In l of 2 Mam"u b HoWtn` Limm S BY SIGNING THIS FORM. THE APPLICANT. OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITIL OR, BEFORE COMMENCEMENT OF THE WOM WILL BECOME FAMElAR WITH, ALL LAWS AND REGULATIONS APPLJCABLE TO WORK PROPOSED. INCLUDING OSHA RECULA7TON3. G.L. a aA. SA CMR 7.N d nil.. AND ANY APPLICABLE MUNICIPAL ORDINANCES, NY -LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WELL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIM THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON TER PROPERTY OF THE OWNET, AND ALSO. FOR THE DURATION OF CONSTRUCTION. AUTHORIZES PERSONS DULY APPODPTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS COVERING SUCH WORK THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JODPI7.Y AND SEVERALLY TO REMSURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMITAND THE WORK CONDUCTED T HURT DER, INCLUDING BUT NOT LIMITED TO ENHURCING THIN REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT. INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH, AND MEASURES TAKEN BY THE MUMCIPAUTY TO PROTECT THE PUBTJC WTIPRE THE APPLICANT OWNER OR EXCAVATOR HAS PAH.ED TO COMPLY 71=&WrM DCL MM POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPAIIIV. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOIYTLY AND SEVERALLY TO DErVM INDEMNIFY* AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABHITY, CAUSES OR ACTION. COSTS, AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PER30M OR PROPERTY DURING THIS WORK CONDUCTED UNDER TUB PERMIT. APPUCANT SIGNATURE DATE 1O -/'V-/O EXCAVATOR SIGNATURE (IF DIFFERENT) DATH OWNER'S SIGNATURE (LIP DWMRErM DAT•Et 2 of 2 TOWN OF YARMOUTH BUILDING DEPARTMENT jar% 1tM6 Route 28, South Yarmouth, MA 02664 508-398-2231 ezt.1261 JUN 242010 v SUILDINGDEPT OMMUNITY EVENT SIGN APPLICATION n is hereby made to Install a Community Event Sign, in accordance with MGL Sect 8, Chap. 85, and Town of Zoning Bylaw Section 303.4.1.1 (except for maximum duration), and the Selectmen's Community Event Sign Policy. An application may be submitted by religious, civic and non-profit organizations. Construction and installation of signs shall be the sole responsibility of the applicant Signs must be approved by the Yarmouth Building Department The locations must also be approved by the Yarmouth Department of Public Works. Signs on town land must be approved by the Town Administrator. Signs on private land must be approved by the property owner. There Is no fee for Community Event Signs. Additional regulations: The size of signs is limited to thirty-two (32) square feet If the sign is double-faced, only one side will be counted for measurement Signs installed and permitted under this policy may be installed for up to 12 months duration, or until the advertised event or campaign Is completed, whichever comes first Renewals may be applied for through the Building Department The content of signs must be non -political and for a non-profit organization. Internal illumination, moving parts, or the appearance of moving parts Is prohibited. The applicants agree to abide by the terms of these laws and regulations. Community Event sign permits may be revoked at any time for any Infraction of these laws and regulations. /) APPLICANT: O r►A1f N -� i j j -j- et S� ` / D //O)r SIGN LOCATION: ,383 �tl {. cis, ram. T ice/• I�Y� ��` CONTACT PERSON: ]QOk0iMXF PH0NE:C7 MAILADDRESS: `1604 a $, azaof yivavai, INSTALLATION 3 REMOVAL DATES: '14.1 .a5)10/0 SIGNATURE OF CONTACTIAUTHORIZED AGENT: 0' Please Note: The Building Department APPLICATION APPROVED BY: APPLICATION APPROVED BY: APPLICATION APPROVED BY: PLEASE NOTE THE FOLLOWING CONDITIONS: APPLICANT A+ 015%%5 EMAIL: -to Date Fe of any change in thhe above Information. 9-2y/0 Is BUILDING PERMIT APPLICATION �0 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE. CHANGE THE USE, OCCUPANCY OF, C I 0 OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. ..,•��5 S Tuan of l:trmouth Building Depitrnnent �'�• • 1 lafi Rottft• 28 • 1Strmrnttlt, ,,11:1021';fi-1-11!1_t a, Tel: 508-398-2231 ext.1261 Fax 508.398-0836 °�' '•--- j Office use only planning Board Inforrrneon Assessor$ Department Information: c~a�. erm@No pate 0 Type My Lot ermit Fee S �/R - onement Data � �/ / Netording Date New 1pOSlt R!C•d. S Date _ pUn No. 1.e Propery Dimensions: I Net Due j � Diner Lot Area(sQ Fronnge(II) LotCororape Signature: Cemficate upancy Y N not requiniA uurr r - Otte lnmrnlaepn 1.1 �VertY Addnfss I 2 orww tnlorpreoore 383 NORTH MAIN STREET 1MVVt�C,oy�/11 Zoning District fa lWldlnf setbacks (111 Water Swpl r (ILO.L e - d0. S be) 13 Flood Public Private Zone: .+wwrr c - r-FOPOrTY UwnershIpIAl 2.1 Owner of Necw* -e l �. TOWN Name 781-935-0130 .aan.uurr a - tAnsuilQion service! 1 3.1 Licensed Construction Suoemlfon 215 Address r WOBURN. MA 01801 781-935-0130 Corrrnerttc BFE. Mating Address: Mailing Address: 781-935-0048 F-� License Number Expiration Date Proposed Use 1 of OVER Contractor comer Home - WAMkoble Q Address RepbN�bn Mer0er SipieNn TN•pl»ne Ejpl ft Deft Section 4 - Workers' nation Insurance Affidavit (KO.L S tS2 S 25C 8) 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 buliding permit. Signed Affidavit Attached Yes ...z.... No .......... Section 5 - Professional Design and Construction Services - for Buildings and Strictures Subject to Construction Control Pursuant to 780 CUR 116 (containing more than 35.000 c f. of enclosed space) SHOWN. LIKWUIST. FEUUCCIO i RABER ARCHITECTS INC. RdApvkabr U 'TdVVW STREET. SUITE A. TANN)U1HPORT. MA 02675 R•pm.•on rw ear Addnu f teg 4r+6tsrCft0508-362-8382 E,q►Nbn OM SI¢aEre TN•phcrft Section 52 Realstered Professional Enainaerlsl am MAJOR ASSOCIATES, INC. STRUCNRAL EHCIN EERCE WAY. P.O. BOX 211R. WOffiTRH_ MA ntant An•af RepdrpWly Deft 617-452-60M R""µme Deft Name A,ee N ReyaMWry Address lRogisnoon N~ WOBURN WTole35 0 2of4 . _ ectlon 0 - Oescdpflon of PropoSed Work (dNrd1 all nppbc") •� '' NOW Wnstructlon ® I Qormuelyebmerosbl No. ofBedroona (rsrmuegleamya+rl No. of Bathrooms EatstlnpBldg. (3 1 Repair(s) Q Aderatform ❑ McIlton ❑ Accessory Bldg. ❑ Type Demolition Other Specify Brief Description of Proposed Work CONSTRUCTION OF NEW LODGE BunDINC @ FLAX FOND RECREATION AREA .use Use A AeeE1r<t ❑ A•1 ❑ A,a ❑ M A4 ❑ s s ONM ❑ ZA ❑ IE EMCATMNAL ❑ *bbdf3— ❑ I Fwrollr . ❑ F.1 F4❑ N /eaN NALYlO ❑ ❑ 1 sWmvllpNAL ❑ F1 1.2 ❑ R❑ REarCH1T1Ai ❑ &1 0 :7 eA ❑ s sTauoa ❑ s 1 ❑ s2 ❑ >. ❑ U Untrn ❑ erecer N AM=L e ❑ specrr s suss I n Use omw. Nc __ uw aiaA: . m h" YWm17e0 CM 3e Ptrraond ►ward krdw Teo C MR 3e Nwpret seas orsben Ir , A bmwm brsb Fbw Amin N rbw No Total Area M Fwots I 2 VrasPw an+CvE Lmgv*M Yq esuawat POW ReNsw Fts**W yes No SECTION 102 OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT e J r - — - S --: as Ownerd the subject pmperty,- I hereby authorize SBAVER CONSTRUCTION INC to act on behalf In I but"atter! relative to work authorized by this butpermd appBuum siry,.a,r. d omw i7 �a 3 of 4 OVER vkgfiTOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 026U (508) 398-=31 ee-1261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-11-161 Applicant Name: William Caci Applicant Phone: 7819350130 Building Location: 0383 NORTH MAIN ST Owner's Name: TOWN OF YARMOUTH Owner's Addres 1146 Route 28 South Yarmouth MA 02664 i Owner's Telephone: (508) 398-2231 (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 10/21/2010 Issue Date: Expiration Date Comments: Map/Lot: 100.1 new construction - Flax Pond Recreation Lodge Building *`X �''"Z'�" 5rCO. REVIEWED BY: 1. WATER DEPARTMENT: DATE: WA: 2. ENGINEERING DEPARTMENT: DATE: WA: x 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: DATE: WA: 5. BUILDING DEPARTMENT: DATE: WA: 6. FIRE DEPARTMENT: DATE: WA: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 10/212010 utnee use uny } Permive,06 Ni Fee S Pemis from Issue date. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department �� �'_ ', Ij 1146 Route 28 South Yarmouth, MA 02664 JA 0 % 2011 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS;--- ASSFSSOR'S INFORMATION: OWNER: CONTRACTOR: Map: Parcel: NAME / PRESENT MAR-INO # Residential Commercial ❑ ESL Cost of Construction $ iy o 1 Home Improvement Contractor Lic # 119Y" —T Construction Supervisor Lic. # 00 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp. Policy# WORK TO BE PERFORMED ❑ Tent (Fate Retardant Certificate attached) ❑ Wood Stuve Shed ❑ Siding: # of Square C ReplacementReplacement windows: # daces: # ❑ Electrical Pemdt # ❑ Re -roof: *of Squares () Stripping old shingles• -The debris will be disposed I declare under penalties; of perjury that the will be Just cause for denial or revocation o Applicant's Signature: owners Slgmmroft • Wpr Vved (or designee) 0 Insulation () going ova layers of existing roof It TVs ❑ Old Kings HighwayMistor is District RoofmglSiding (Uke for Uke) she and correct to the best of my knowledge and belief. I mdcruand that my false mswer(s) under MAL m. 268, Section 1. • r.". / _J '/ L L"Y Zoning District: Mtorical District Yes 4 Flood Plain Zone: Yes 1( Water Reso Protection District Within 100 f� of Wetlands: ') V No tl= No "I The Commonwealth ofMassaehusetts Department of lndus&W Accidents Office of Investigations 600 Washington Street Boston, MA 02111 '%+:' www mamgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AVV1IC2nt Information Please Print Ledbly Name(Binmess/OresairatiorAndivirhrali• :2(/ 2 A rr, —r. r Al Address: Are you an employer? Check the appropriate box: 1. ❑ 1 am a employer with 4. ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).' have hired the sub -contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling ship and have no employees These sub•contraetors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9. ❑ Building addition required] 5. ❑ We ere a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work • officers have exercised their - 11.❑ Plumbing repairs or additions myself. [No workers' comp. insurance right of exemption per MGL 12 ❑ Roof repairs required] t 3a. ❑ I am a homeowner acting as a c. 152. §1(4), and we have no employees. [No workers' 13.[:l Other general contractor (refer to N4) comp. insurance required) ;Any applicant thin checks box al mad also tall nut the section below Ong rhea werkm' orrmpeosatiad i"�cy iotormation. tCantnteoe that cheek this box mum aaaehed "'additional sheet slowing the name of rye subeoanaetms and must ege whit a r or M thou indicating such employees. u the sub•cwtnctas have employees, they mum provide dw w workers' •• or sot those entities have comp• Policy numbs. I am on employer that Is providing workers' compenxsadon Lcsurance for my employees InfOrmadom Below is the policy and job site Insurance Comnanv Name: Policy N or Self -ins. Lic. Job Site Expiration Date: City/State/Zip: Attach a copy of the workers, compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $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 eeno under that the information provided above Is urge and correct /l Qdle'd are only Do 1 of write in this area, to be completed by city or town of)JeiaL City or Town Permit/l.Icense N Issuing Authority (cirele one): 1. Board of Health 2. Building Department 3. Cltyfrown Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone M: Information and Instructions . y Msasechusem Genasl Laws chapta 152 requites off CMPWYdm tn previds worketa• compenatkn for their empbYCCL pad to this statute, an wllolw is defined as'.»erery passe in dw service of 000tha under any mntrsd of hh*, express or brQHed, oral or written" An emptioper, is dcfiwd so "an iodtvidual, Puft"% ip, � •W ^ corporation a other legal eadtl, or any Q of the tarspoiog engaged is aj� �rR • and iochsdlag the legal repose -who of a deceased mgbri� dw receiver or Itusteo of a huffy" parmaahilk saooiatic s cc allow kW entity, employing employees Howorm the owns of a dwelling loose bovbng not more than that tpartmmta and who reside thaein, of Its osxvpd of Ile dwolliog boa" of sm&w wbo employs passes to do maintenance, cansntuetlos a repair work on such dwelling law or m the Rounds or building appurtenant thereto shall sot because of such employment be deemed to be an emploW MQL chapter 152, 125Q6) don states that "tnry stags w local ikeadK a gamy AM wlihhdd ile hanana w rewwal of a Hos sus w psfmk to opauto a badness or to I I I ' buddings to the asmsnwalth fir W spptlreat wha lore M preduesd wept" evldeare of camp Wna with do iwaraaa a vRaP ngatrsi» Adds oodly. MOL cbaptaw 1S2, ILIM States "Ncidw tbo cossmoawealeh nor W of it'poHdcal mbdNWons aban I mu bera ny eontrset turtles palbcmw= of public work until acceptable wMeace of compHaoce with the bwwzwf cequ4emeses of this cbapea have beet pseseased to the eaotaae-1 ambocity Plea" im out th. workers' affid"It compteay6 by c the bases did apply to your situation an4 it wessory. supply t°'ts) °sm0(s). oddreu(n) and phone somber(,) along with &* cestieeate(s) of wffumnm Lisubw Liability Compaia (1LC) or Limited Liability Partnership (LLP) with on employes, other thus the ambers or l� an our � to carry workers• conVenutloo to rssu ce. Ilan LLC of LLP don have Accso the Departinant of Eodustrw idents s� s policy b pq (ices f' Be advised that � ew Is � and data the sIDdavW The atIIdsvit shadd beep' ecidmis As e @ city r re of do, desar eovasp M the of In tenoned to duo cite or tow■ that the appH ue se the the permit 11the law or if � � ohtai a wakens• Industrial Aaeidentt Should you bars any 4oeatios repudisg comsenaado s policy. pia" call the Deporwest at the samba listed below. SelAsrsed Cospades should erns their City w Two Officials Plea" bean that the affidavit is complete and primed legibly. Ths Deportment bus provided i Spam OR the honour of the affidw k flow You to fill out lo the -rent the Office of Invadpdm bee to contact you regarding the s"I""o' Ples" be use so fin In the Pam WHasee Wombat which will be used a s miss. umnI In addition, ea appHted thd cars submis muldplo pamddlken" oppHcadoos is any ii'n yin. sted only submit css affidavit Wksthtf emrent Polley logamatlor (if wceaary) and u Ww "lob site Addtese" tht spplkaas should wrist "ail loesti ese in ----(City of town" A Copy of the offidwvk that bee bore offiCW1y ataaped at mocked by the city at tosser my be provided so the eppliced a proof that a valid affidavit is on Me br lisnse Vomits of Ikenom A new affidavit must be filled ass tech year. When a home owes a cidma is obtaining a urea, a paint correlated to any birioea or co®ereW vesture (Ls. a dog Han" or paroit to burs leaves sae.) said- is NOT sequined as coalpka this affidavit Tb a Office of lavesdptlons would ham to dash you is advance for your cooperation and should you bare W gmebw. please do not besitab to give m a csLL Irk Depctorat•s addcna, ttlepbow and fa: mmsbrr The Commonwealth of Massachusetts Department of Industrial Accidents Otlla of Investipdosa 600 Washington Street Boston. MA 02111 Tel. N 617-7214900 ext 406 or 1.877-MASSAFE Fax N 617-727-7749 Revised 11.224)6 www.mm.gov/dia Massachusetts - Del Board of Building F Construction St ue:nw. CS tttoo Reslrktedtsc. oo.. . RICNAROP. COURt 158INDIANTRL ,.1�. DENMSPORt, MA Q2670 e�.G -diaYw� . of Public Safety n and Standards License 5MT12M2 25W7 V E E MIIA Property And Casualty Group, Inc. One Winthrop Square WORKERS COMPENSATION AND Boston, MA 02110 EMPLOYERS LIABILITY ncr•� wowr'.. .. CONTRACT # 10-210 #1 MEMBER NAME AND ADDR cc. YARMOUTH, TOWN OF TOWN HALL.1146 ROUTE 28 SOUTH ARMOUTH, MA 02664 #2 CONTRACT PERIOD: FROM 07/01/2010 TO 07/01/2011 AT 12:01 AM STANDARD TIME AT THE ADDRESS SHOWN ABOVE #3 SCHEDULE OF OVERAGES: A Workers Compensation Coverage: Part One of the contract applies to the Workers Compensation Law of the Commonwealth of Massachusetts. B. Employer's Liability Coverage: Part Two of the contract applies to work In the Commonwealth of Massachusetts. The limits of our liability under Part Two are: Bodily Injury by Accident $1.000.000 Each Accident Bodily Injury by Disease $1,000,000 Contract Limit Bodily Injury by Disease $1.000,000 Each Employee #4 Note: Contribution: The Contribution for this contract will be determined by our Manuals of Rules, Classifications, Rates, and Rating Plans. All Information on the extension of information page is subject to verification and change by audit DEC 9, EXTENSION MWC 003 (0704) OF INFORMATION PAGE, MWC 001 (0799), MWC 002 (0799), DEC PAGE 9 P� ax1/ rtls piry�ss� . 3 � VL f f M D 30 rl FicAn 0 / Alb- �onc� �'�lc. ce n U I m �g ��✓�j�. ��,t�s�S 1 4 y 'OA A 71,k/ f 0 b f'rlpyF SITE PLAN REViEW" LW SHEETortnal X IMomral_Review LOC13110n: MJ NO Mal AReei AOUM TarMODU1 tone: r14u ne5luenual Persons Present: Jim Brandolini Amy Von Hone Peter Johnson -Staub ho Terry Sylvia Bruce Murphy George Allaire Gary Damiecki Jonathan Sawyer Protect Summary The applicants propose to raze an existing assembly building at this existing Use Code N9 Municipal Recreation Use facility and replace it with a 3,630 square foot mufti -purpose 9odge' building. The new building would house a mufti - purpose assembly room, offices, storage, kitchen, nurse's station, camp store, venting area and restroorns and would be used primarily in support of an existing summer camp program. Site parking and the entrance driveway would be reconfigured to accommodate 124 vehicles. The proposed parking area is to be partially paved, but the site is open year 'round for various activities and is not seasonal in use. Comments Building (1)A special permit is require pursuant to Table 202.5 Use N9 Municipal Recreation Use. (2)124 parking spaces are being proposed which appears to be consistent with what was proposed in March,1986 (see Site Plan Review notes). The Site Plan Review Team waived the pavement requirement on March 4, 1986. pursuant to zoning bylaw Section 301.4. (3)The current Site Plan Review Team voted 4-0-0 to reaffirm that vote on the basis that although the use of the proposed building may not be restricted to seasonal use, the use will be non simultaneous with the other uses beyond 180 days. The SPR Team made this vote with the condition that should the lack of paving cause problems in the future, paving mitigation may be necessary. (4)Sfte Plans shalt be stamped by a surveyor and civil engineer. It shalt also depict the scale. (5)AII work shall comply with the applicable provisions of 780CMR and 521 CMR. (6)Use Group is A-2r. (7)The proposed parking buffers are less than 20 feet required by Section 301.4.4. Compliance shall be met or relief sought via a special permit pursuant to Section 3012. Community Development: Not present, but offered the following comments: The renovation of the Flax Pond Recreation Area will benefit Yarmouth as a community by enabling the continued and expanded operation of various programs, and In particular the summer camp, that benefits a great number of Yarmouth children and their families, many of whom are working families that contribute to the local economy. The camp also provides summer employment for older youths and college students. An essential component to Yarmouth's overall quality of life, this project represents a substantial Investment In our recreational Infrastructure. Conservation: Not present. Design Review, Not present (Design Review Is not applicable to the project). Engineering: Not present. Ir . Building requires a fire alarm system and requests consideration of a carbon monoxide system for the few times people will be sleeping overnight. Access for fire engines and Tower 41, including a surface with adequate structural surface support for the equipment, must be provided. A 14 foot wide road/walkway to the building from the parking area Is required. Parking lot must be configured to allow access for Tower 41. Health: State plumbing variance will be requested for reduced plumbing fixtures. Will also request State DEP variances for (1) a tight tank for phase one, where building will not have any toilet facilities, (2) no pressure dosing for a septic system over 2,000 GPD, (3) no VA aftemative septic system for a septic system of 2,000 GPD within a zone II drinking water supply. Aprox 320 campers with a design septic flow of 10 GPD/camper. Some of the future cabins/shefters should have a sewer line for possible sinks or toilet facilities. New building will have a occupancy of 200 and maybe built in phases, with second phase the construction of toilet facilities. Phase I maybe sinks only and possible pumped to existing septic system, as review of this system. Alternative option to State DEP variance would be local BOH approval with Administrative Consent Order to delay above stated septic requirements until future established septic constriction date (typically 5-7 years). Tannin : No comment beyond those provided by others in this review. Water. A meter pit will be located in the front of the structure. Plumbing will run to meter pit .ti SITE PLAN REVIEW x FORMAL INFORMAL June 15, 2010 TO: _ASSESSOR (w/o plans) _CONSERVATION _PLANNING DEPT (3) Planning Design Review (Au comm. South of Rt 6) Econ. Development _HEALTH DEPT _ENGINEERING DEPT _FIRE DEPT _WATER DEPT Town Clerk's Office (2) w/o plans -for posting _BUILDING DEPT FROM: James D. Brandolini Building Department SUBJECT: SITE PLAN REVIEW AGENDA TIME: 1:30 1 NAME OF PROJECT: ' Flax Pond Recreation Area w 2 J _ tir ADDRESS: 383 N. Main St. c MAP:100 Lot: 1 Chair: Building ite Plan F1 ias been_n to June 15 at 1 301 problem on the 8 . sched uled 1. SITE PLAN REVIEW x FORMAL INFORMAL June 8.2010 TO: _ASSESSOR (w/o plans) _CONSERVATION _PLANNING DEPT (3) Planning Design Review (An comm. south of Rt 6) Econ. Development _HEALTH DEPT _ENGINEERING DEPT _FIRE DEPT WATER DEPT Town Clerk's Office (2) vy/o plans -tor posting _//BUILDING DEPT FROM: James D. Brandolini Building Department SUBJECT: SITE PLAN REVIEW AGENDA TIME: 2:30 NAME OF PROJECT: Flax Pond Recreation Area ADDRESS: 383 N. Main St. MAP:100 Lot: 1 Chair. Building (M6 •""'R�lvvvri yr rliruvlVuIrl 10 BUILDING DEPARTMENT ly 1146 Route 28, South Yarmouth, MA 02664 :;,r 3'` 508-398-2231 ext. 261 Fax 508-398-0836 SITE PLAN REVIEW APPLICATION t� Date: S %� For Office Use Only: Review Date 0 Time 25 Property Address: 383 N. Main St., Flax Pond Recreation Area Assessors' Map 100 Parcel(s) 1 Zoning District: R-40 Flood Zone: Business Name: Town Of Yarmouth N/A Applimt'sNa se: Recreation Department Owner or Corp. Name (if different): Applicant's Address: 1146 Route 28, Yarmouth, MA 02664 Applicant's Phone No.• 508-398-2231 ext. 1270 Engineer/Surveyor's Name(s): Description of Proposed Project (attach additional pagm if necessary): New camp building and parking area to include demolition of two existing buildings. List of aD Hazardous Materials and Quantities (attach additional pages, if necessary): 300 children Is the Proposed Construction Within 100 Feet of a Wetland? Yes No X Is Zoning Board of Appeals Relief Anticipated? Yeses_ No List and Attach Copies of Prior Board of Appeals Decisions. This information can be obtained from the Board of Appals Office. Signature of. Peter JoVfison-Staub Assistant Town Administrator P".05M 1 TOWN OF YARMOUTH BOARD OF APPEALS s /Filed with Town Clerk: 19 19�G"' Hearing Date; 3/13/86 PETITIONER: Yarmouth Park Commission 6 Petition No: 2283 Recreation Commission 1146 Route 28 '86 MAR 19 Al :041 39 3 South Yarmouth, MA 02664 � � X/.%M/%/� DECISION IONn JF =° [ "tt'� /00./ TOWN CLERK & TFEASLRi!l The petitioner r quested from the Board a special permit to allow Municipal Recreation Use (N9) on Lot A2. Assessors' Map179, Flax Pond Recreation Area. To retain the following buildings: Forum, Lodge . Motel, Arts, Lodge3, Dining Hall, Pond House. Condo, Cottage Dorm A 6 B toilets ( all as commonly known) as accessory uses to Municipal Recreation. Members of Board of Appeals present: Donald Henderson, David Oman. Leslie Campbell,_Fritz Lindquist, Richard Heitz. It appear ng that notice of said hearing has been given by sending notice thereof to the petitioner and all those owners of property deemed by the Board to be affected thereby and that public notice of such hearing having J been given by publication in The Register on February 7. 1986 and March 6. 1986 the hearing was opened and held on the date first above written. The following appeared in favor of the petition: Phil Whitten; Albert Frey; Neil Bottomley. The following appeared in opposition: None. REASON FOR DECISION The Petitioner requested a special permit to allow Municipal Recreation uses at the Flax Pond Recreational Area and to retain several buildings as accessary uses to Municipal Recreation. This property was taken by the town at the 1985 Town Meeting for Conservation, Recreation and Wellfield purposes. A plan by the Yarmouth Engineering Department dated 2/12/86 was submitted as was a memorandum. Various nearby residents spoke in favor of the proposal. The Board finds that the request will not cause any undue nuisance, hazard or congestion or any harm to the established or future character of the neighborhood or town. Consequently, the special permit is granted as requested, construction and demolition to be in accordance with the above plan and memorandum. Members of Board voting: Donald Henderson, David Oman, Leslie Campbell, Fritz Lindquist. Richard Heitz. Therefore, the petition for special permit is unanimously granted. No permit issued until 20 days from date of filing decision with the Town Clerk. Myer R. Singer C er FLAX POND TDti\ Cr YALM.XITH ,,``,,��}}• eaArr cr Arrtr,Ls Or :F �1%.f T&: NAME a Town of Yarmouth FEB 27 P 1:25 ADDRESs: 1146 Rt. 28, South Yarmouth, MA. 02664 HEAPING VIE: a-i_y .; prrITIONER: NAME: Yarmouth Park Commission/Recrea.UQn.Commission tiN iv Yc. • t,. CLERK d IREASUhd.1i ADDrrss: 1146 Route 28, South Yarmouth, MA. 02664 BOARD Or APPEALS, YARMOUTH. PASS. This petition when completed and signed must be filed with the Board of Seleet- r.en, Yarmouth, P.assechusetts, along with the fee of $ 75.00 A$3 aV DATE: Februarv21. 1986 PAID: Request Waiver of Payment 1. I, We, hereby appeal from decision of the Building Inspectcr tn_ petition your board for a public hearing on the action checked below: � 1. Review refusal of Building Inspector to grant permit. 00" 2. Decision. of Selectme :. 2. I, We, hereby request the action checked below: 1. Variance from requirements of Yarmouth Zoning By -Law. Approval of the Board of Appeals. 3y A special permit from the Board of Appeals. To allow: Municipal Recreation Use (N-9) on Lot A-2, Assessor's Map 79 Flax Pond Recreation Area. To retain the following buildings: Forum, Lodge 1, Motel. Arts, Lodge 3, Dining Hall, Pond House, Condo, Cottage, Dorm A 3 B Toilets (all as commonly known) as accessory }}� uses to Municipal Recreation. it J 3. Reason for the Board of Appeals action as checke3 1. Contrary to Zoning by-laws as follows: . 1. 2. 3. 2. Approval of Board of Appeals, or Special Fe =`t ze=-ester Under the following section of Zoning By -Law: 1. Section 202.5 - Use N-9 2. certinn 104 2 Names and addresses of abutting property owners, and thoic je_rsons deemed affected by this application. (At least three.) signed ' _ . _... _=E ArnICANTt FLAX POND RECREATION - REP: PHIL LOCATIONt 383 NO. WAIN STREET, SOUTH YARMOUTH ASSESSORS' MAP M 79 RECREATION AREA PARCEL A A-1 6 A-2 DATE: MARCH 4, 1986 FIVE SETS OF PLANS SUBMITTEDt YES.NO PERSONS PRESENT AT KMEW HEARINGt' �TYYt. p �S o BILL (nRC-eJE Rt JL- W H I TTE Aj aRJcc r-ImArNf- COMMENTS: J%u t-M- rvr SCE wo / a u--n.0 I rL.02"Sr C/ ire v,-a�_� �. _ -i.. Tr r .-. v ie.,, iC-t /1 L� M •7C/ C� / 1 �' I ` / $C [f re Ll4P� Je Ae w om v (Tot k�. `.E �2 k SIGNED t BUILDING DE BOARD OF M ENGINEERINC FIRE DEPT: WATER DEPTt N TOWN OF YARMOUTH PARK DEPARTMENT 74 TOWN BROOK ROAD TELEPHONE 775.7910 WEST YARMOUTH. MASS. 02673 RE: FLAX POND RECREATIONAL FACILITY - (Board of Appeals) The property taken at the 1985 Town Meeting was for Conservation, Recrea- tion and Wellfield purposes. The land for the Flax Pond Recreation Area was taken in October of 1985. The facility was originally operated as a seasonal overnight boys camp for 140t and a staff of 40. There were 17 buildings in use on the location. The Recreation Department has identified the anticipated uses for the up- coming 1986 season and future. They consist of: A summer playground program Tennis court use. Basketball. Picnic area Beach area and swimming Softball for adults, children b the handicapped Horseshoes, nature walks and lifecourse The tennis courts, basketball courts and softball fields exist. A gate has been installed to control access and to secure the area thereby avoiding vandalism. The Building Inspector reviewed the proposed uses and determined the maximum spaces required and what should be built initially. We determined which build- ings should or could not be saved or were not needed for the various programs. Both Commissions and the Exec. Secretary were informed and agreed to the need to demolish 7 buildings and renovate 3 others. The various buildings requested for accessory uses are in a condition worth saving and maintaining to support and house some of the recreational. programs. They will serve as summer offices, program centers, rain day classrooms, training rooms and bathrooms for the activities. The dining.hall may be made operational or a small concession area put in. The removal of the buildings will improve the quality of the area and eliminate use and maintenance problems. We are working with the Conservation Commission while doing this. The proposed parking is located in the center of the active recreation area, central to all activities and away from both wellfields, runoff contained on site and unpaved with trees kept in accordance with Section 301.4.6 of the Zoning By -Laws. Handic6pped parking spaces.3%.but_not_less than 4 spaces. Sanitary facilities have been designed and are acceptable to the Board of'Health-and-the Plumbing Inspector. One of the renovated buildings will be accessible to the handi- capped. Agreements with the Water Department as to use and restrictions of maintenance on the ballfields are being formulated. We anticipate daytime and early evening use only. No overnight activities. Park to be closed and secured at night, possibly with full time caretakers on the property during spring, summer and early fall. The decreased use and elimination of most all showers will lessen the septic and waste water impact on the ground water supply. The number of users could be less than what was occuring each day when the camp was in operation. Other than the playground program, softball and some instructional programs, the use will be open to the public. The entrance off North Main Street is divided into an entrance and exit by an island and has good visibility in both directions with undeveloped Water Department lands to the right and residential property to the left. The uses are buffered from the surrounding neighborhoods. We have requested a special permit for Municipal Recreation Use and to retain various buildings as access- ory uses. We do not feel the proposed use creates any undue nuisance, hazard or congestion in the manner we propose to operate the facility. Dated: 3/13/86 soon . FILE COPY BROWN LINDQUIST FENUCCIO & RABER ARCHITECTS, INC. 1 January 2011 Mr. James Brandolini, Building Commissioner Yarmouth Town Hall 1146 Route 28 South Yarmouth, MA 02664 RE: Construction Control Progress Report No. 2 V. New Lodge Building @ Flax Pond . j 83 N. rna vn . Yarmouth, MA Dear Mr. Brandolini Since our last Construction Control Progress Report in mid -November, we have conducted several site visits to monitor the construction work and adherence to our construction documents for the subject project. As of this date, the following general work has been completed: ➢ Underslab plumbing and electrical rough work had been completed, backfilled and compacted ➢ The interior concrete slab with perimeter insulation has been installed. Although originally constructed incorrectly, the contractor has corrected the slab edge detail for the proper code - required thermal break. D Rough framing is nearing completion. D The roof sheathing along with roof shingles have been installed D Rough plumbing has been completed and inspected by the town D Rough electrical and mechanical work is nearing completion D Windows are expected to be on site and installed in about a week. The work completed to date by Seaver Construction, Inc., and their subcontractors, has been completed in a good and workmanlike manner, and in general conformance with the drawings & specifications. All required town inspections for work completed to date have been completed. The structural engineer of record has visited the site twice to inspect tie -downs and anchoring hardware per design. (See attached reports). Please fund attached construction progress photos and the structural report. 200 WILLOW STREET.SUITE A PH 505-562-8382 VARMOUTHPORT.MA 02676 WWW.CAPEARCHITECTS.COM FAX 505-062-2828 If you have any questions, please feel free to contact me at anytime. Sincerely. le Richard Fenuccio, Principal-m-Charge CC. Jim Lefler (Yarmouth DPW) Bill Caci (Seaver Construction) Dennis Mason (Seaver Construction) Tim Sawyer (BLF&R Architects), Project Manager ALLEN & MAJOR ASSOCIATES, INC. 100 Corffiserce Way P.O. Box 2118 Woburn, MA 01888.0118 Field Report #1 Ta M1j935.889 Fax- (78l)935-2896 Client: BLFR Report �11"- November23, 2010 NI Project: Flax Pond Recreation Area A&M Proj 36 . Location: Yarmouth, MA Contractor: Seaver Construction Weather. Clear Temperature: 50 Date of Site Visit- November 19, 2010 Time: . From: 10:00 am To: 11.00 am Present at Site: Ten Sawyer (BLFR) Brian Walsh (A&M) Reported by: Brian Walsh"' The following Kenn from previous reports are outstanding or resolved as indicated: None. The following was noted: 1.1 Observed foundation wall formed In place and In the process of being badcfilled. FoundatbnA)oting geometry is consistent with the design documents. 12 518" diameter general stud wall anchor bolts are cast In place at 48' centers. 1.3 Cast -In holdown anchorage for the HDUS and HDU8 holdowns are not in the stem wall per schedule on A/S0.4. These anchorages win need to be drilled and set in Simpson AT adhesive. An anchors should be drilled, cleaned and instaIed In accordance with adhesive manufacturer's recommendations All drill holes must be cleaned with a wire brush and compressed air. Drill depths provided here account for the reduced wall section at slab shelf and should be measured from trip of foundation wall. Please notify BLFR/A&M in advance of ddring so that confirmation can be made of anchorage depth and preparation. Written report from testing company, and/or observation by BLFR/A&M, arKVor photographic documentation will be required for drilled anchorages of HDUB's. 1.3.1 HDU8 holdowns, 7/8" rod, 1"drill hole, 24" deep 1.3.2 HDU5 holdowns, 5V rod,11116* drill hole, IS" deep. civil & structural engineers • land surveyors • environmental consuhants • landscape architecus wwwaUen=jorcom 1.3.3 HDU2 and HDU4 perAWA. IA Perimeter deck pier footings are observed in place and bacdiiled. 1.5 Except as specfic* noted herein. the work is observed to be progressing in accordance with the sinrdcaal design dowm ds. 1.6 The nwd structural observation by A&M is required after rough frame of the structure; but prior to application of roofing materials. Ideally all framing hardware will be installed at this observation The above Items were reviewed with the project superintendent prior to my departure from the site. t� a welsh, P. Structurat Department Manager Emd: Ewd9tDd*nrrzIorcom a paon 2 AUEN EN & MAJOR ASSOCIATES, INC I00 Cormncr= way P.O. Ball 2118 Wobiun, MA0188MI I8 Field -Report #2 F 081)935-28ac (78l) 935-2896 Clleft, BUR Report Date: December 23, 2010 Project Flax Pond Recreation Area A&M Project M 1203 36 . Location: Yarmouth, MA Contractor•. Seaver Construction Weather. CloudyAJghtRain Temperature: 40 Date of Site Visit: December 21, 2010 Time: From: 1230 pm To: 2:00 pm Present at Site: Tim Sawyer (BLFR) Dennis Mason (Seaver) Kevirh Poore (A&M) Reported by: Brian Walsh The following items from previous reports are outstanding or resolved as Indicated: 1.3 Cast -in holdown anchorage for the HDU5 and HDU8 hddowns are not in the stem wail per schedule an A/S0.4. These anchorages will need to be drilled and set In Simpson AT adhesive. A I anchors should be drilled, cleaned and installed in accordance with adhesive manufacturer's recommendations. All drill holes most be cleaned with a wlre brush and compressed at Drill depths provided here account for the reduced wag section at slab shelf and should be measured from top of foundation wag. Please notify BLFR/A&M In advance of drilling so that confirmation can be made of anchorage depth and preparation. Written report from testing company, and/or observation by BLFR/A&M, and/or photographic documentation will be required for drilled anchorages of HDU8's. 1.3.1 HDU8 holdowns, 7/8' rod.1' drill hole, 24' deep 1.32 HDU5 hddowns, W rod, 11/16' drill We, 18' deep. 1.3.3 HDU2 and HDU4 per A/S0.4: [12-21-10[: Adhesive anchors had not been Installed as of this observation. Additional Information regarding holdown and anchorage placement was Included In a sketch sent to T. Sawyer on 1Z/W010 and was discussed with D. Mason prior to my leaving the site. civil & strtrcaual engineers • land attrveyors • emir===tal consultants • landscape architects www.alktmmjorcom The following was noted: 2.1 The purpose of the visit was to observe the overall building framing and hardware. 22 Observed typical am bbddng and perimeter bearing conditions installed In accordance with the structural design docurre s. 2.3 Observed rake overhang blocIdng installed In accordance with the structural design documents. 2.4 Observed ridge beam arid hangers at conventional framed roof. Ridge straps had not been Installed at the trm of this observallm D. Mason stated that they would be installed prior to roofing materials being placed Pictures of this item will be forwarded b A3M confirming proper installation when crnpleted. 2.5 Observed drag truss at interface with conventional rod to have plywood spacers placed and ready to receive sheathing to be pieced between the drag thus and the stud wall. SheathN will be placed to the utlerside of the sloped roof sheathing within the limits of the shear walls Wong this Ins. The diagonals of the drag truss are to be nailed to the intersecting studs through the sheathing once in place. 2.6 Typical gable arid bracing was riot Installed fully at the time of this observation. D. Mason stated that the additional blocking at the roof level would be installed prior to roofing nahrlais being placed. Pictures; of this Bern will be forwarded to A&M confirming proper Installation when completed. U Required 3f16'A27u2" plate wvashers were not observed. In follow up phone callon 12=W10 to D. Mason, he confirmed tat they would be instated within the limits of all shear walls. 2.8 Column bracing for the two full height PSL columns, on the gable end (grid line 1) require an alternate bracing detail to the one shown in detail VS5.1 as the columns were cut off below the top plate and not extended to the uderside of the roof sheathing. An alternate detail will be coordinated and blued as an SK 2.9 Except as specifically noted herein, the work is observed to be progressing In accordance with the strucWmI design doarnerrls. The above items were revfewred with the p *d superintendent prior to rry departure from the site. r � / 0 Pme 2 .7r _, c� 3'°l �s JN• 'III t;dYAP - /._ { 8F� is k t t� - y U � r W 4 ` n APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Elcerri A Code, (MEL). 527 CMR 12.00 (PLEASE PRINT IN INK OR TYP To the Inspector of Wires: By this work described below. Location (Street & 2007 N (OFFICE USE ONLY) (Rev. SIM By Fee: S t PERMIT —0'7- 2R AT'IOW% Date: V re the undersigned gives notice of his or her intention to the electrical Owner or Tenant OS U r 776 r A'a9'le O Telephone No. %lGfs Owner's Address flf Is this permit in conjunction with a b�urilding permit? ❑ Yes o (Check Appropriate Box) Purpose of Building _Reexy� X;Al — Cori Utility Authorization No. Existing Service AW Amps i 0 / 14 2��Volts Overheats Undgrd ❑ No. of Meters New Service Amps' / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed electrical Work: Completion ofthe followine table may be waived by the fnstrectorofWres No. of Recessed Luminaires No. of Ceil.-Susiz.(PaddielTransformers o. o'rotal KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Aboven- SwimmingPool md. ❑ md. ❑ o. o Emergency lighting Bane Umu No, of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat rap Totals: um r ons — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal ❑ Local ❑ Connection Other No. of Dryers Heating Appliances KW Securityysiems: No. of Devices or Equivalent No. of Water Heaters KW o. o No. o Siens Ballasts am Wrong: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Tel No. f Devices norw uivgalent Attach additional derail if desired, or as required by the Inspector of Hires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE\ BOND❑ OTHER❑ (Specify:) (Expiranon Date) Estimated Value of Electrical Work: (When required by municipal polity.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penal[i s f perjury, aS the information on this application is sue and completS. q FIRM NAME: %�J!✓N (Jf �?/1,'/ %s/G• // ���' A LIC. No. / 6 r Y(�A Licensee: SignarurcLIC. NO. (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: Address, Alt. Tel. No.: *Security System Contractor license required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below. I hereby waive this requirement. 1 am the (check one) owner owner's agent.❑ Owner/Agent ` Octo21..2�0006 12:38PM No.4320 P. 1 0 �.c TOWN OF Y A R M O U T H REArION DIVISION 1 ►7 42410uTE 28 WE'r'YAI�MOUlIi MASSACtPJSETIS 02673 ' ldephonc (508) 79p•9133 - Pax (Spy) 79"152 Director ernall: rccrrntinnpyarrom&ma.ua Particia U Armsrrmg, C.P.R.P. Assisraac Director Nicholas coccinlri Fax cover sheet 38� 'N To: AJrcc� 4/- Attn: old Fax: 68--3 From: Yarmouth Recreation Department Fax: (508) 790-9152 Phone: (508)790-9133 Date: L 27 Subject: �o v- Number of pages including cover sheet: 6�d P,naO a gw.yd.a Apr i Oct,27. 2006 12:38PM No.4320 P. 2 TOWN OF YARMOUTH 424 RO=,. 28 vn$r YARmoumi MtiS5ACiiiISFM. 02673 Teleplwne-60A) 790-9133 - Fax (`>(A) 790.9152 cm¢fd: ncrc2[inn0y2rmnuQj.ma.u, Halloween Haunted House & Egg Hauat 2006 RECREn'nON DIVISION I im= Patricia M. Acmmong, C_i? R.P. Assisinni L)irccmr NidwLn Cacciolfi The Halloween Haunted House at Flax Pond will be conducted between 5:30 — 7:00 PM on lAday October 27, 2006. All staff have been trained in emergency procedures and understand where all exits, fire extinguishers and staff will be in case of an emergency. Most staff is CPR & First Aid ratified. To the building we have installed emergency lights, illuminating exits signs, three fire extinguishers and a PA system for emergencies. All materials used in the house have been treated with inspects -shield for fire resistance. All staff will have flashlights for emergencies. An Adult PIC is centrally located in the building and is in charge of all the actors and happenings in the house. There are 2 tour guides to be with each group of no more than 10 people that tour the house at a time. Glow in the dark arrows have been painted on the floor to guide patrons in the right direction to exits. The Assistant Director is the main person in charge of the whole program Second in command is the Program Director. In any case of emergency staff Is to report that emergency to either person immediately as they have 2 way radios to contact each other. Emergency Procedures JEI mergrency 1. Remain calm. 2. Do not move the injured person 3. Stay with the person and send another staff member for the AD_ Emergency Procedures: Fire - fire extinguishers located in middle of building and by each exit. 00,21. 200612:38PM No.4320 P. 31 - PIC to turn on fights and instruct all patrons to exit building immediately through exits on PA - AD to call 911 - Program Director to get crowd back along with Tour Guides - AD to make sure all patrons/employees exit the building double check head counts Medical Emergency on Property In Building - StaffMembers will report the emergency immediately to PIC of Haunted House. - PIC will turn on all lights and direct all patrons to exit the haunted house through either exit on PA system. - AD to call 911 emergenq personnel Program director is to' assist the person with the Medical issue along with one other staff member. - All other staffis to keep calm and report to the PIC for further duties to keep crowd calm and away form the scene. Outside of building -AD to call 911 Program Director to assist person with medical emergency along with tour guides. -All others to report to PIC for further duties such as crowd control, flagging down emergency personnel_ Oct,27. 2006 12:38PM No.4320 P. 4' AFFIDAVIT OF FLAME RETARDANT TREATMENT USING INSPECTA-SIIIELDT' I HEREBY CERTIFY THE FOLLOWING INFORMATION: NAME OF APPLICATING PERSON OR FIRM :gr,c,4 . IZtc_r�t�k� �SI/ic��rJ ADDRESS fly itowVe _R �f-k��?Ar^oA MA e5nf,7g TELEPHONE # SGBS Wd -9433 FAX o S8 1 e — 15 ADDRESS OF ITEM(S) TREATED e9 n . I �385 X16-k ,dam ITEM(S) TREATED Ali AW,,g 8 ind A&4. lm*fL TOTAL SQ: FOOTAGE OF TREATED AREA TOTAL GALLONS USED /c�allor✓ O The above listed materials have not been submitted to the manufacturer for flammability testing due to circumstances beyond the control of the applicator. Product has been applied at coverage rates to these items which are similar to items that have been previously treated and tested for compliance through independent testing laboratories. DATE /0/Z7/06 Name (print) Signature Y�.•w.1� %�c��fijiv ' Firm Photocopy this form for your future use for Flameproofing Affidavits. OLL-21. 2006 12:38PM No.4320 P. 5 )h J. Pe Inc. PU SALES OFFICE AND PLANT p �x Falmouth Road (Rote 261 339, HnMfl ue .,- S TO PAY ALL T _ OF COIIl:CTIOW� CuJcu Ar NS WE* ODIC E• OF T-)2% PER MOP ODIC REASOW LE aTfCfWEY 3AL13 AND vjCE Beach point Ile B. Truro, MA 02666 NU Tef. (S06) 467 'It, 29967 TOWN OF YARMOUTH BOARD OF APPEALS FILE COPY E •`. Hearing Date; Filed with Town Clerk: � �9 � _���� �`. PETITIONER: Yarmouth Park Commission 6 REPetition No: Recreation Commission q 1146 Route 28 '� We 19 A11 :U4 ►�h 383 South Yarmouth, MA 02664 10Nn JF •t C. )V.mj/Al /do./ DECISION TOWN CLERK h TFEASURiJ( The petitioner re quested from the Board a special permit to allow Municipal Recreation Use 09) on Lot A2. Assessors' Map079. Flax Pond Recreation Area. To retain the following buildings: Forum. Lodge Motel, Arts, Lodge3. Dining Hall. -Pond House, Condo, Cottage Dorm A 6 B toile-ts ( all as commonly known) as accessory uses to Municipal Recreation. Members of Board of Appeals present: Donald Henderson, David Oman. i' Leslie Campbell, Fritz Lindquist, Richard -Weitz. 3/13186 2283 It appearing that notice of said hearing has been given by sending notice thereof to the petitioner and all those owners of property deemed by the Board to be affected thereby and that public notice of such hearing having been given by.publication in The Register on February 7. 1986 and March 6. 1986 the hearing was opened and held on the date first above written. The following appeared in favor of the petition: Phil Whitten; Albert Frey; Neil Bottomley. The following appeared in opposition: None. REASON FOR DECISION The Petitioner requested a special permit to allow Municipal Recreation uses at the Flax Pond Recreational Area and to retain several buildings as accessary uses to Municipal Recreation. This property was taken by the town at the 1985 Town Meeting for Conservation. Recreation and Wellfield purposes. A plan by the Yarmouth Engineering Department dated 2/12/86 was submitted as vas a memorandum. Various nearby residents spoke in favor of the proposal. The Board finds that the request will not cause any undue nuisance, hazard or congestion or any harm to the established or future character of the neighborhood or town. Consequently, the special permit is granted as requested, construction and` demolition to be'in accordance with the above plan and memorandum. Members of Board voting: Donald Henderson. David Oman. Leslie Campbell, Fritz Lindquist, Richard Neitz. Therefore, the petition for special permit is unanimously granted. No permit issued until 20 days from date of filing decision with the Town Clerk. M er R. Singer C erc 42.4 uµlt; of iLgh+ aiz 64FPT. 42.6 of 41.6 (PrAdo- ev T 41.0 ' j rows / � n 110, RU I e 1 N. Oro Holum IN ,- 100 •o 100 cm:: pcai __ f'.r EMENTS FLAX POND ........ /Pn,� r TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 ' PERMIT NO 603925_ ......... �C��I� `a r. ISSUE DATE :_ _ 4R4103 _ _ : PROPoe use ; APPLICANT TowNOFYARMOtJTH JOB WEATHER CARD ADDRESS :1146 Route 28 PERMIT TO Repair AT (LOCATION) 100383NORTH MAIN ST <1 I Z ING DISTRICT R-40 SUBDIVISION MAP LOT BLOC 1100.1 BUILDING IS TO BE USE GROUP LOT SIZE F CONST TYPE CONTR'S 089187 strip and reroot, paper and vent to code REMARK AREA (SO FT) EST COST ($ 578,800.00 PERMIT FEE OWNE TOWN OFYARMOUTH ADDRESS 111148ROUtO28 BUILDING DEPT BY LICENSE CONTR'S NAM (Gaudreau, John INSPECTION RECORD FIELD COPY Date, Note Progress • Corrections and Remarks Inspector pemlkf 03—� S - Feei�J% Frm@ete. 6 mwAs from issue dace EXPRESS BUILDING PERNIIT APPLICATION TOWN OF YARMOU M Yarmouth Bm7ding Department 1146 Route.28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 261 CONsr UCMNADDRM ' 383 eyel-AA mvf,y s%1 5,�YAr.41ow7`o MR ASSESSORS WOPIR ATM- Mom= IUD IPar«I: F.'-J-;;•aN7 U ,)04A,^ Gflu0 E/9L( - --- D R ctida�al Est Cast of C INtM m S ��. SOOro 0 H=c'awr� camactwIm#-/239/o Caratr+sctimSupervisorIlc 9 C s o6 / 6 7 Wor tstsm 5 Campemabm h=== (Cbe& me) . ❑ Iamtbehomemmo Iammeadepmpriesor0 llm��v//eWarkdaCampemafim5rs�oe - )assmmlceCamp�gNamc ar1MMlNI f GfAyCs(I�� jNs Warimescamp. Poacyt Tad WORKTOBEPERFORMED Dnotieo 0Si&W iofSgmes ❑ Repheetand windows: I f # of Sgmes O ok UBiBwc lsyersofeAstiagroof .-tLedebris vMbedisposed ofat 0 RgAwcmeotam. I.ecado¢ of Faci[4 Idedarcmdap�lfirsotpajeytLstSestasemmtshaeata aretroeaodoortatbthebeg ofmyknowledge and belief Isoaerstandthrt wry 5lsesoawer(s) willhojustmumfor donutormo mofsoy&CMsodforWONCIES ntnderMO.I..Ch.26kSectiont Applicaws Sigos, 0 Zoning District: 2 v o iiisto icel District O Yes %, No Flood Plain Zo= ❑ Yes 1;�No Water Remmm Pro mUm District Within 100 R of Wetlm&: Yes t7 No 1 Yes Q No 0 3 M _� ✓�� Qo,wrnwvimlu y.lrauow.�.�.rcr f �. r� 8 _: j � Board of BaBding Regulations and Standards t.r HOME IMPROVEMENT CONTRACTOR Registration: 123910 Expiration:0gn3/1003 . Type. DBA Gaudreau Construction Co. JOHN Gaudreau 131 Prospect St Ludlow, MA01056 Administrator * 7-1�atiBOALATfO11! Illimmovidiz WOW { Tr. fame 25W j t 11 ERAFIARD 10 . VIIIII NRAHAAA IMA fidW Ado v _FIELD COPY . T-02-124 TOWN OF 7A4 BUILDING PERMIT APPLICANT Philip WUttCU/TOVn of Yarmouth ADDRESS1146 Route 28• SY 02664 INO.) (STREET) (CONTR'S LICENSE) _ PERMIT TO demDltiSOn NUMBER OF I_) STORY DWELLING UNITS j iriFE OF NT) no. iFRO ED wc) 383 North Hain Street. SY 02664 R40 AT (LOCATION) D115TIRICT (NO.) (STREET) - BETWEEN AND �• O O ICROSS STREET) (CROSS STREET) o SUBDIVISION 100/1LOT LOT BLOCK SZE o BUILDING IS TO BE FT. WIDE BY FT. LONG ay -FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION C Z ' I TO TYPE USE CROUP BASEMENT WALLS OR FOUNDATION O (TYPE) REMARKS: d-,14-h tb• 01d, CYIYt,IeZ, hoaae Yith4m tho Flat P"A rPwreatinn roMplPy- AREA OR PERMIT ICUSICISWARE FEET( VOLUME ESTIMATED COST $M/A -FEE $ N/A OWNER Tenm of Yarmouth ADDRESS - 1146 Route 2R- SY 02664 BYILDINC DEPT. TOWN OF YARMOUTH Building Department (508) 398-2231 ext.261 PERMIT NO � _ _6-02-792 _ ISSUE DATE 3/26/02 - _ : PROPOSED USE APPLICANT ,TOWN OF YARMOUTH ADDRESS :1146 rRoute 28 ---------------------------= BUILDING PERMIT JOB WEATHER CARD ............ PERMITTO ; Demolish ------------ I AT (LOCATION) 00383NORTH MAIN ST ZONING DISTRIC R-40 I I SUBDIVISION MAP LOT BLOCK LOT SIZE REMARKS BUILDING IS TO BE CONST TYPE demolish flax pad caretakers house AREA (SO FT) EST COST ($ 1$0.00 PERMIT FEE ($) OWNER TOWN OFYARMOUTH ADDRESS 11146 rRoute 28 BUILDING DEPT BY USE GROUP CONTR'S LICENSE 0 CONTR'S NAME THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLUC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1) FOUNDATIONS OR FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL MEMBERS (READY FOR LATH OR FINISH COVERING) 3) FINAL INSPECTION BEFORE OCCUPANCY 4) REFER TO DETAILED INSPECTION CrUcmu e APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FINAL INSPECTION HAS BEEN MADE REOUIRED FOR ELECTRICAL I WHERE A CERTIFICATE OF OCCUPANCY IS PLE%UMBING AND MECHANICAL REQUITED, SUCH BUILDING SHALL NOT BE INSTALLATIONS. 404441. • • r'h #14 POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS 1 1 lJ 2 2 \ 2 3 OTHER 1 / 2 3 4 5 WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION INSPECTORS INDICATED ON THIS CARD CAN BE ARRANGED FOR BY TELEPHONE OR WRITTEN NOTIFICATION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED =oV-1AR� , TOWN OF YARMOUTH BUILDING DEPARTMENT OI y BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTIAL SHEET Building Site Location Proposed Improvement: Al n Address: No: _Lot No: / -' The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. WATER DEPARTMENT: ENGINEERING DEPARTMENT: CONSERVATION CON MISSIOI HEALTH DEPARTMENT: FIRE DEPARTMENT: REVIEWED BY: Determines Compliance of Water Availability and or existing location. 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, Marshland, Etc Determines Compliance to State and Town Regulations; i.e., Requirements 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. 1. WATER DEPARTMENT: DATE: N/A 2. ENGINEERING DEPARTMENT: DATE: N/A 3. CONSERVATION: DATE: N/A 4. HEALTH DEPARTMENT. DATE: N/A S. WIRING INSPECTOR: DATE: N/A 6. PLUMBING INSPECTOR: DATE: N/A 7. FIRE DEPARTMENT: DATE: N/A PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF /, M N DATE: 3 -2S- O,Z Witte copy— Buaifing Dept.- Yellow Copy —Health Dept - Piok Copy— EngrAcrm6 DcpL - GoWcomd- Fue neglCauervabm Flit-X This Section for Office Use On - BuildingPermit Number. - Date Issued: Signature: < ✓? Zy p y - Certificate of Occupancy _ . Building ' ial -- - - ate - - --. is Is not required Section 1 - Site Information 1.1 Property Address: 30 A/c/u y 1i%-MI JrnFFT S 12 Zoning Information: ,2yp Zoning District Proposed Use 1.3 Building Setback* (it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1 A Water Supply (M.O.L c. 40. S 54) Public X Private 1 S Flood Zone Information: - - Comments:. - - - - - Zone: L BFE: Section 2 - P 2.1 Owmr of Telephone l�Hi7l� Name 11q Mailing Address: Telephone Mailing Address: SAP• 77s7571lk Telephone Ta 9-15-99 1 of 4 OVER 32 Registered Home Improvement Contractor. Company Name N" Applic" Address Registration Number Expiration Date Signature Telephone Section 4 - Workers' Compensation Insurance Affidavit (M.G.L a'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 - Professional Design and Construction Services - for Buildings and Structures Subject -,°, to Construction Control Pursuant to 780 CMR 116 (containing morn than 35,000 c.f. of enclosed space) ; Section 5.1 Registered Architect Not Applicable Name (Registrant): Registration Number Address Signahrta Telephone Expiration Date - Section 52 Registered Professional En inee s Name Area of Responst " Address - Signature Telephone Registration Number Expiration Date Name Area of Responsmilay Address Signature Telephone Registration Number Expiration Dare Name Area or Respombiiity Address Signature Telephone Registration Number Expiratbn Date Name Area of Responsibility . Address Signature Telephone Registration Number Expiration Date - Section 5.3 General Contractor. - NotApprtcable - Company Name . Person Responsible for Construction .. Address Signature Telephone 9.15-99 2of4 bhUlION 10tj OWNER/ AUT ORIZEDAQENTDEGLARATION� as Owner/Authorized Agent hereby declar that the statements and Information on the forgoing application are true and acurate, to the best of ml knowledge and belief. Signed under the pains and penalties of perjury. - Print Date Section 11 1; OSTIMATED CONSTRUCTION COSTS.-n nB1^ - Esarated cost (Dollars) to be completed M permit applicant 1. BuM ft 7 Electrical 3. Ptumbkq 104 - 4. Mechanical AC & Fire Protection - - &Total-(1+2 3+4+5) - 7.1otalSquaretto'nwr JNtba) I I Check Below I ❑ Cons4wation-Commission R6ng (•d appr)caele) ❑ Old gs Highway 6 Historical mmission approval (H applicable) 9.15-99 1 4 of 4 Section 6 Description of Proposed Work (check all aoDBcablet New Construction ❑ 1 (for multiple family ony) No. of Bedrooms For multiple family only) No. of Bathrooms Existing Bldg. ❑ I Repair(s) ❑ I Alterations ❑ I Add -Rion ❑ ' r Accessory Bldg. ❑ Type Demolition Other Specify. Brief Description of Proposed Work: PEFV99U5H 771E O(,D CR �7�9 c%£�S y0!/fE ltiii�/iN F A=I k 1-100 . /7FC,eF*-T701V &vW, Section7= Use Grotto and Construction Tvna Building Use Group (Check as applicapable) Construction Type A ASSEMBLY ❑ A-1 ❑ A-2 ❑ A-3 ❑ to El B BUSINESS ❑ 2A 2B 2C ❑ ❑ - ❑ E EDUCATIONAL ❑ F FACTORY ❑ F-1 ❑ F-2 ❑ H HIGH HAZARD ❑ 3A 38 ❑ I INSTITUTIONAL ❑ 1-1 ❑ F2 ❑ 1-3 ❑ M MERCHANTILE ❑ 4 R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ - R-3 ❑ SA so Ll S STORAGE ❑ S-1 ❑ S-2 ❑ U UTILITY ❑ SPECIFY: M MIXED USE ❑ SPECIFY: - S SPECLOSE ❑ SPECIFY: Exlstlng Use Group: ExMng Hazard Index 780 CMR 34 Section 8 Building Height and Area Proposed Use Group: Proposed Hazard Index 780 CMR 34 u Building Area EAsting of appncable) Proposed Number of Amm or stories krklde basement levels F1aorArea per Fbor (so Total Area All Floors (so i Total Height (it) Section9-sTRUCTURAL-PEERREVIEW (780CMR 11011)' I Independent Strucblral Engineering Structural Peer Review Required Yes ...„„„. No .„„„„. I BUILDING 1 , as Owner of the subject property, hereby authorize my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date to act on 9.15-99 3 of 4 OVER BUILDING TOWN OF Y A R M O U T H ELEGMCAL 1146ROUTE28 SOUTHYARMOUTH MASSACHUSEITS0267 51 GAS Telephone (508) 398-2291, Ext. 261 — Fax (508) 898-2365 PLUMBING SIGNS BUILDING DEPARTMENT DpMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuan to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereb certify that the debris resulting from the(�roposed work/demolition to be conduct d at 3�3 /V01UH �1'l4�,�f `1%7ZE6T Work Address is to be lisposed of at the following location: Z/L"16 P771 LIvDfIL-- Said di posal site shall be a licensed solid waste facility as defined by M.G.L. Chapte 111, Section 150A. Signature of Applicant Permit No. Date S TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth,•14TA 02664 508-398-2231 ext. 261 BUILDING DEPARTMENT TOTAL DEMOLITION SIGN -OFF FORM Building Code (780 CMR) Chapter 1, Section 112.1-Service Connections • • L•••• • �• « • u• •-• • u• �• • • • • _.�•� •.I ••� • • • -• • • " • • • • • • • 1 • • r • • • • - • • • • • • 1 • . • "All debris be disposed of in accordance with 780CMR 111.5." FLAK PouD Buildmg.or Structure Location: CAQei-A:KEGS Map: 100 Lot: 1 TOwN 0 t= 110- Coum Z8 y A mvvTti Address: S, Y�,Ugvh( Phone: SDS • 39ff Z231 Owner'sName: Contractor Name: MtoFM Address: Ybg K Phone: 903.77SWID Commonm ealth Electric: Date: 3-/.2-0-2 By. r P�Q&w E- S>��� Title: tU-CnuwQ;•, Colonial as: Date: IVO By: Title: Water De t.: Dat 0'7itees. B 3.13 �Ir"1�:a�.. Title: 0-dv� Board of ealth: Date: By: Title: D Condition: •� w I 1n4s Rr e N F•!/r� Tti •, Scr wd. CCr55� Fire Dep Date: By: 1� ` Title: pop Z sir Hutorie ommissioa: Date: By NI or Title: x ado � TO: FROM: RE: DATE: Please be pumped c cc: file POLE MEMO Yarmouth Board of Health Phil Whitten, Dir. Parks & Cemeteries Flax Pond Caretaker's House Septic Pumping & Fill April 26, 2000 Used that the beehive septic at Flax Pond for the Caretaker's House was April 24, 2000 and was filled with sand on April 25, 2000. TEL: (508) 432.0530 ? A C 7 d "V'f ROBERT B. OUR Co., Inc. GREAT WESTERN ROAD - NO. HARWICH, MASS. 02645 //�� (� DATE -1 - NAME'Ok"t PC5f\Cf C..- A. V �•A' STREET CESSPOO TANK(S) PUMPED: S�_ EXTRA HOOKUP: LINE SNAKED: �pa Gl ri'' S SERVICE CHARGE DUMP DUMP F= CASH REC'D S TOTAL S Ot r � - TERMS -CASH - •� 02 - THIS IS YOUR BILL - l'+aa TOWN OF YARMOUTH Building Department = Town Hatt Yarmouth, MA 02664 (508) 398.2231 exLM BBUILDING PERMIT APPLICATION RECEIPT Applicant Name: Location: Owner's Name: Owner's Addres Philip Whitten 00383 NORTH MAIN ST TOWN OF YARMOUTH 1146 rRoute 28 South Yarmou MA 02664 Owner's Telephone: (508) 398-2231 (OFFICE USE ONLY Recorded By. IC Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 3120/02 Issue Date: Expiration Date Comments: demolish flax pond caretakers house This is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official Building Permit will be Issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee. Date Printed: 3/21/02 MEMO TO: Building Commissioner FROM: 'Philip L. Whitten, Director Parks & Cemeteries �IJ��►�N� SUBJECT: Demolition of caretakers house Flax Pond DATE: March , 002 W/XGf/ /9 ZDe'';7— Attached please find the completed Building Department Total Demolition Sign -off form. /Wp Opw Onod The Landfill will work with the Park Division to remove the building and dispose of the debris in the proper manner. The Conservation Administrator has given his approval for the removal of the building and grading of the site. Would you please issue the appropriate permit. Thanks -� TOWN OF YARMOUTH `T-02 jfie f BUILDING PERMIT / FIELD COPY ' %3 •a�- /c78 ��y�L DAT3 ,J11T1!_ 14P 2002 PERMIT NO. — 0 .. APPLICANTChris Lee � 85 Abens Rd WY 02664 ��LCS.08088 - ISO.) (STREET) (CONTR'S LICEN5EP - PERMIT•TO DECK it"A NUMBER OF STORY DWELLING UNITS )TYPE OF IMPROVEMENT) NO. IPROPOSEO USEI AT(LOCATIONI 383 No. Hain St SY 02664 R40 INO.) (STREET) a BETWEEN AND ... 0 ICROSS STREETI ICW55 STREETI LOT p SSUUBBDIV15TON 'Poll J " LOT BLOCK SIZE ' O BUILDING 15 TO BE / FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION - m U IZ .7 TO TYPE SB USE GROUP I A3 BASEMENT WALLS OR FOUNDATION ¢ (TYPE) —.R�MARKs:_Deck-Replacing existing deck as per plans submitted 6-6-02 AREA OR VOLUME ESTIMATED COST $ 4320.00 ,I"IT $$ 12 6.00 (CUBIC/SQUARE FEET) OWNER Town -of Yarmouth _ n� ADDRESS 1146 Rt 28 SY 02664 BBUILDING DEPT DATE INSPECTION RECORD NOTE PROGRESS • CORRECTIONS AND REMARKS INSPECTOR , N� y� iu.SE �s 44 00',9ZI L' a 300"( - NOIlY01 NoLLOOtl1SNOO NI NaOIN02 MVHS ONV 1N913H NU. - lOY, •T - - • - 433Y15 GSOtl01 v = Oh2I 1:)lYuia .+. '• . 7111NOI - - i S11NI7 9NT3MO _ tl3YWON = -`R33 Moso -SDI 1799Z0 3M - - _ .<ON uvWad- t � F; 1011v011VA 70 hP aZ ^.Adoo3lu idaa.-= Fl�olia�nddr io aslasl �o iu�fuV a SSUGGV . t Aj,Ti00<SES <�p UAOf, l tl3NMO'. 1 r ! t F:' rl]]!'ltlYfWS/01Yl101 i SmnlOAYO Yu3tlM� _ r { :SSItlV W3tl st 9N10L(16' Yr 1 n y I OOi- Naswaaog -t .'�13jYlY Si0Y3v• - :. �-.- �-. 1133tl181 s s ' coup *t9.9Z0..3s. �S cIIZEyd ott £8£ 1N011VOO111V - - y OM-UYlN3A0YlNIfp 3dAtt'-:;-' - WH-ad AN01$ O1 lINa3d: SatlOOY ,� = 2a'j SIj q:) 1NV311ddr'; v TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 = PERMIT NO B-02-1078_' B/q2 PERMIT �. ISSUE DATE : 6%; : PROPOSED USE : _ _ _ _ _ _ . _ _ . _ ;Tbwri of fth- . - - • - - - - • - - - • -: JOB WEATHER CARD- APPLICANT YXAIi ADDRESS :1146 Route 28 PERMIT TO Repair AT (LOCATION) OF NNORTH MAIN ST 7 ZONING DISTRICT JR40 —777771 SUBDIVISION MAP LOT BLOCK 1100.1 BUILDING IS TO BE LOT SIZE f I CONST TYPE 4 rebuild demolished deck REMARKS AREA (SO FT) EST COST ($ 54,320.00 PERMIT FEE OWNER TOWN OFYARMOUTH ADDRESS 11146ROute2B BUILDING DEPT BY USEGROUP A•3 CONTR'S LICENSE 080884 CONTR'S NAME Chris Lee THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLUC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1) FOUNDATIONS OR FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL MEMBERS (READY FOR LATH OR FINISH COVERING) 3) FINAL INSPECTION BEFORE OCCUPANCY 4) REFER TO DETAILED INSPECTION SCHEDULE APPROVALS APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE JOB AND THIS CARD KEPT POSTED UNTL SEPARATE PERMITS ARE FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL WHERE A CERTIFICATE OF OCCUPANCY IS PLUMB ING/GAS AND REQUIRED, SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 2 2 � 2 \ 3 OTHER 1 f 2 3 4 6 WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INSPECTORS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION ABOVE. BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. Town of Yarmouth Building Department 1146 Route 28 • Yarmouth, NIA 0266-1-1492 Tel: (508) 398-2231 x261 • Fax: (508) 398-2365 -- Office Use Only Permit No. ' %d pate � ✓ Permit fee $ I G' pp"��," � Deposit Rec'd. $0 l`-'Date Net Due $ 0 --` - Planning Board Information yl Assessors Department Information: - Map Lot►+eo a too 1 oie - New 1.4 Property Dimensions: -Lot Area (sQ - - . Frontage (n) -- Lot Covmge Endorsement Date Recording Date Plan No. : Other - - This Section for Office Use Only Building Permit Number: Date Issued: Signature: Building Official 6 - - ate �� - Certificate of Occupancy .' Is is not t;"'requtred Section 1 - We Information 1.1 Property Address: 12 Zoning Information: Zoning District Proposed Use OZ 1.3 Building Setbacks Ift) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided D bOr a o lots f a o /odl 1 A y (M.O.L c. 40. S 54) Public Private 1.5 Flood Zone Information: Comments: - - - - Zone: G BFE Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: Name (print) I (1fA A Signature one•, Mailing Address t ' Y Telephone VMA 22 Authorized Agent: AX Name (print) Signature C� fat T - Mailing Address: \ w Telephone Section 3 - Construction Services 3.1 ens ed traction Su rsor. Not Applicable ❑ License Number / Add ss - Signature - Telephone say Expiration Date y . u 9-15-99 1 of OVER 3.2: Registered Home Improvement Contractor_ Company Name - Not Applicable ❑ Address Registration Number Expiration Date Signature Telephone Section 4- Workers'Compensation Insurance Affidavit (M.G.L c 152 S = (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 -Professional Design and Construction Services -for Buildings and Structures Sub)ect ;_ _ to Construction Control Pursuant to 780 CMR 116 (containing more than 35,000 c f- of enclosed space) Section`5.1 Registered Architect: Not Applicable ❑ Name tReylatrantt: Registration Number Address Signature Telephone EV6atbn Date Section 5.2 Registered Professional En ineer(s) Name Area of Responsibility Address Signature Telephone Registration Number Expiration oate Name Area of Responsibility Address Signature Telephone Registration Number Expiration Data Name Area of Responsibility Address Signature Telephone Registration Number Expiration Date Name Area of Responsibility Address - Signature Telephone Registration Number EWretlon Date Section 5.3 General Contractor - Not Applicable ❑ Company Name Person Responsible for construction Address Signature Telephone 9-15.99 2 of 4 Section 6 - Description of Proposed Work (check all applicable) New Construction 0 1 (for multiple family ony) No. of Bedrooms (for multiple family only) No. of Bathrooms Existing Bldg. Repalr(sPW I Afterahons ❑ I Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief D nption of Proposed Work 11K!0111(fle-7 Old Section 7 - Use Grouo and Construction Tvoe Building Use Group (Check as appficapable) Constriction Type A ASSEMBLY ❑ A-1 A-4 ❑ ❑ A-2 A-5 ❑ ❑ A-3 (� 1A 1 B ❑ ❑ B BUSINESS ❑ 2A 2B 2C ❑ ❑ ❑ E EDUCATIONAL ❑ F FACTORY ❑ F-1 ❑ F-2 ❑ H HIGH HAZARD ❑ 3A 30 ❑ ❑ 1 INSTITUTIONAL ❑ 1-1 ❑ I-2 ❑ 1.3 ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ SA 5B ❑_ / S STORAGE ❑ S-1 ❑ S-2 ❑ U UTILITY ❑ SPECIFY. M MIXED USE ❑ SPECIFY: S SPECIAL USE I ❑ SPECIFY: :.omplete this section If existing building undergoing renovations, additions and/or change in use. Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34 8 Builddino Heiaht and Area Number of floors or stories Floor Area per Floor (s0 Total Area All Floors Total Heiaht (ft) ion 9 - STRUCTURAL PEER REVIEW (780CMR 110 andent Structural Engineering Structural Peer Review Required TION 10a OWNER AUTHORIZATION =TO BE COMF 4ER'S AGENT OR CONTRACTOR APPLIES FOR Bl R Yes_._..... No.......... , as Owner of the subject property, hereby authorize Ohm.4¢ e to act on my behalf, in all matters relative to rk horized by this building permit application. re of Owner - Date 9-15-99 3 of 4 OVER z 10b DECLARATION r- 1QX r� r�P&? t✓011 , as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name ,144 �L —�— Date Section 11 - ESTIMATED CONST LICTION COSTS - - Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building 2. Electrical , 3. Plumbing I Gas 4. Mechanical (HVAC) 5. Fire Protection 6.7otal-(1+2+3+4+5) 7.Total SquareFLIbnanrticana6admm ) Check Below ❑ Conservation -Commission Fling (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) 9-15-99 4 of 4 e TOWN OF YARMOUTH r- 5 BUILDING DEPARTMENT `i1-SFp CONSTRUCTION SUPERVISOR FORM PLEASE PRIM. Job Location: - Number S VSPi lage Owner of Property: Construction Supervisor. Address: Licensed Designee: (If other than Supervisor) Name License No. Phone No. 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 Anylicenseewho shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother 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 departmem 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 curren Lability insurance poricy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes Sz No ❑ If you have checked=, please Ind to the type coverage by checking the appropriate box. A liability Insurance porky ir 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: of Owner or Owners Agent s Owner ❑ Agent ❑ Signature://ls�.r/�7�/ Building Official Approval: Failure to secure coversge as required under Section 25A of MGL 132 can lad to the imposition efcriminal penalties of ■ 0na ■p to one years' imprisonment as well as civil penalties Ia the form Ora STOP WORK ORDER mad a fiat of 11100M a day agsiust me. Is COPY of this statement maybe forwarded to the Office of Investigations of the DIA for cove rsge veri0utiem. / do hereby certify under the pains and penalties ojperjury that the information provided above lr late and eorncc Signature )= Print name otGcial use only. do not write in this area to be completed by city or town official city or town: YARHOIITQ ❑ cheek irimmediste response is required contact person: permit/licease a nBuildiug Department ❑Licensing Board 261 ❑Selectmen`s OBlet ❑l 50$ 3 ic lth Department ( phonca:_ �� 98-=31 eat. nOther that ■ ft 1w 1.13 IOAI 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 emplitrer 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 I5_ section :5 also states that even• state or local licensing agency shall withhold the issuanee or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor 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 permitnicense 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 Mloe III Imsfiliden 600 Washington Street Boston, Ma. 02111 fax H: (617) 727-7749 phone #: (617) 7274900 ettt. 406, 409 or 375 TOWN OF YARMOUTH 1146R()L7E2N S()L7H )*AM10L7H AASSA CHL'SETIS(r_'ti W4451 Tclephonc ta(IN1 :S!IN-•�':51. E_Ct.'_'lil — Fas Lil)81 :4y1i-•!'Ifci 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 workaddren A . is to be disposed of at the following Said disposal site shall be a licensed so ' waste fat \ as defined by M.G.L. Chapter 111, Section 150A signature of applicant date permit no. BUILL)IN ; ELE(TRI( : t.ti I'LL'�IBi�t 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. Six proposed site plans, stamped by a Mass. Registered Professional Land Surveyor, showing all boundaries, proposed setbacks, existing & proposed grades / contours, proposed location of structures), parking, curb arts, 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 — Mevadon orflood-proofing certificates (whichever Is applicable), shall be submitted prior to the issuance of a cerddfu:ate 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. Addifions 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 50% of the structure value (substantial improvements). Alteratdons 1. Same as above, except existing & proposed conditions shall also be shown on the plans. NO WORK IS 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. INSPECTION SCHEDULE NEW CONSTRUCTION, ADDITIONS & ALTERATIONS The receipt of a building permit is not the end of the permit process, but rather the beginning. The budding permit holder is responsible for arranging the required inspections before proceeding with additional work. Failure to do so may result in having to expose concealed work through the partial or complete removal of some building elements, causing you delay and unnecessary expense. It is imperative that you arrange for the following inspections by either calling 508-398- 2231, extension 261, or make a personal request at our office at least 48 hours in advance: FOUNDATION • After certified 'as built' site plans have been submitted • Before concrete floor is poured • After perimeter drain has been installed • Before backfill • Before first deck is constructed • After damp proofing • After certified flood zone elevations have been submitted (when applicable) Note: When proposed plans specify re -enforcement rod installation or other unique design criteria you are required to call for an inspection prior to pouring the concrete. In some cases a separate inspection may be required for a strata/soil or footing inspection. FRAME • After rough electrical, plumbing & gas approvals have been made • Before insulation • After being made tight to the weather FIREPLACE / CHIMNEY • When smoke chamber is complete • When chimney is complete (may be inspected with frame) • Final INSULATION • After building envelope is completely insulated FINAL • After all other inspections have been approved • After electrical, plumbing, gas & fire inspections have been approved • After all applicable historical applications have been completed • After an applicable flood elevation certificate has been submitted ON 5"'i�t� �tQatQ �'"a� S�irfn.�a `�CePJr X�2�•7S IT � I I t r-41 OF it tit 1 - f.� �. i /o 1 I IOftv{ 1 I { I � it L I K s 21 I i� ! i i I Qo ITS✓ 0 /� j ' — �orsr9nr�T $e s-U f sSyc i ;. i "i%a✓LD L5 M rdrt oZ 16)r nut r s f i 1 I j �• � /� D' tViri# 1411 agow / iY s i I 1 1 1 1 1 � � 1 f } 1 1 i •! � � ( IJ ' 11~ 6'� �•: CGS i I � � ��— I h I v1 °f YqR b TOWN OF YARMOUTH BUILDING DEPARTMENT Building Site Location: Address: BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITITAL SHEET No: Lot No: The Building Departmerl will be responsible for assisting the applicant by dispatching your plan J applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING or application to the following 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; LeIf Lot(s) Bader any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays. Marshland, Etc HEALTH DEPARTMENT: Demmin s 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 RNmr ements for Personal Safety, Property Protection; Le., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: I. WATER DEPARTMENT. DATE: N/A 2. ENGINEERING DEPARTMENT: DATE: N/A 3. CONSERVATION: DATE: N/A 4. HEALTH DEPARTMENT: DATE: N/A INDUSTRIAL AND/OR COMMERCIAL PERMITS 7. WIRING INSPECTOR DATE: N/A 6. PLUMBING INSPECTOR DATE: N/A 7. FIRE DEPARTMENT. DATE: N/A PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATUREOFAPPLICANT: DATE: Whkem-Buildin6Dm•- Gn wpy.WakrDepL YeOow Copy -Heath DmL - Pmk Copt' -En inw*DeM - Goid -Fue De Wmwvadm Building Site Location: -TOWN OF YARMOUTH -BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITITAL SHEET No: Lot No: The Building Department will be responsible for assisting the applicant by dispatching your plain ana or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; Le., If Lot(s) Bader 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; Le., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A 2 ENGINEERING DEPARTMENT: 3. 4. N/A i. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR. DATE: N/A 7. FIRE DEPARTMENT: DATE: N/A COMMENTS: :L a 2 Lw PLEASE NOTE tLvti! nr-(� U:(44�D 617/02_ RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: White copy -BmldnDept -. Ommeopy,WsftDepL .Yd1owCopy-Heft DepL - Pink Copy-Eagh=*Dcpe - Odd®vd-FheDW)Cmtavadw I t1 1 1 I I r . f , f { View 4 i°M r 1 1 ; � 1 -- - - — - �L is.-�- 1 I � 1.6 - -- r- } ....... - - I fi # s I 1 � � i 1 I I t i I TOWN OF YARMOUTH 1 y3 al" /. P2 BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTIAL SHEET Building Site Location: Proposed Improvement No: Lot No: Address: / / t/% 4& Ig TelNo.: �2� 33 I Date Filed: The Building Department will be responsible for assisting the applicant by dispatching your plans am or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal ---------------------------------------------------------------------------------------------------------------------------------------- Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: G� I. WATER DEPARTMENT: l DATE: I O N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS S. WIRING INSPECTOR: DATE: N/A 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: White copy -Building Dept- Giceiicopy - Water Dept. - YdIm Copy -Hahh Dept - Pink Copy- Engineering Dept - Goldemud-Fke DepXoamiatim I 1-4 • 1 , .. - - - - - -- - 47- --[1 t a ■■■■ .. ■ lomi ■■■■immM■■■■ ■■■■■■■■■■■■■■■■■ ■■MEMO ■ ■ ■ ■■ ■■■■ ■■ ■■■■ ■■ ! ' I _ I t-- -r - t I i t -t -+ t i_ _, . _I - i i_ I T_ t i T �t' - T i_ t I i I i t. t 1 Ti i� I I j I 1 I 1 I I I j r I I � I 1 j I I i j i r- - - - -- T 1 t ti + , _ I L. -- - - - -i- } 16 i } � AA p �IIrt1' 1 i � t l Y _• Ir 1 4 1 , 1 1 i [UMMMi7 TO: Building Commissioner FROM: Philip L. Whitten, Director Parks & Cemeteries SUBJECT: Flax Pond Demolition Permit DATE: April 11, 2002 As required by the Demolition Permit B-02-792 this is to notify you that the demolition debris from the removal of the Caretakers Cottage at the Flax Pond Recreation Complex were disposed of at the Yarmouth Landfill. The debris were transported by Town trucks from the demolition site to the disposal area I would also like to request a Site Inspection. APR 2002 I �1. TOWN OF Y A R M O U T H ELEAUTLCDMIN1NGGAL 1146ROUTE28 SOUTHYARASOUTH MASSACHUSEI'I'S02664-4451 GAS Telephone (508) 398-2231, Fxt. 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-WER-1'v� WIMIYAlK F4,+K POND work Address ie-ee^be disposed of at the following location: X4&jw w mwasl r Wq�S Said disposal. site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Si ature of Applicant 1302 790S Permit No. A9iut�¢-na✓ D� Date 4—/-AA cC#JaI RIo v P41F o^R TOWN OF YARMOUTH ��O �%� ,°_ '•BUILDING DEPARTAZENT BU LDING PERMrf APPLICATION DEPARTMENTAL SIGN OFF •TRANSMITTIAL SHEET. Building Site Location QMapsNo: .otNo: Proposed Improvement d cn v f%J f.r, i .:.; s;.: The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUR DING WATER DEPARTMENT: . , Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliancrto State and Town Regulations; Le, Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; Le., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: 1. WATER DEPARTMENT: DATE. NIA: 2. ENGINEERING DEPARTMENT: DATE: N/A: ' 3. CONSERVATION: DATE: NIA 4. BEALTHDEPARTMENT: DATE: MAL INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR DATE: NIA 6. PLUMBING INSPECTOR DATE: 7. FIRE DEPARTMENT: DATE: - N/A COMMENTS: �.. �LD_� D> I�itoYsOF LANDF/GL-�iFNQP IytfEK �Gl,Cb i �r1lPL/�T�D RECEIPT OF COPY: SIGNATURE OF white Dopy—Bidldng Dept- Yellow Copy—HaMDept" - Pink CoPr—EnnPmricgDe{R - Goldenrod-F6e Dq VConsevadw APPLICANT COPY BUILDING 3i PD CIS PERMIT NOT VALID UNLESS <RIlPERLY RECEIPTED SY CAS IER// TtYa\ OF xaP�IOL"tH PERMIT VALIDATION DATE ITxr[h 27200 PERMIT NO. E-02-742 APPLICANT PhIllD yhltttn/! v—n Of Tarimmth ADDRESS 1146 RDnte_28, Sy 01664 (NO.) (STREET) (CONTR'S IJGEN3E1 PERMIT TO . d9=Qllt'1on (_�) STORY - NUMBER OF (TYPE OFIMFgOVEY[NTl DWELL ING IINITe -- IPROMSED USE) AT(LOCATION)_383 Aerth hale Street ST 02664 - ZONING O1 (BTREEn DISTRICT R40 BETWEEN (CROSS STREET) AND ICROSS STREETI SURnMCIMM IflFl/I LOT BLOCK jT E BUILDING IS TO BE FT. WIDE BY FT. LONG BY F7. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: a��nl A�thS� T' } w i+we.aa 3dthlu the via — AREA OR VOLUME B. ESTIMATED COST $—11IA PERMIT (CUBIC/SQUARE FEET) FEE $ TQiA OWNER TOI— Of TAr-w",lPN ADDRESS- 1146 It iA n 0266E BUILDING DEPT.BY OF ANY AFPLILAVLa ouo u...................-....... INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1. FOUNDATIONS OR FOOTINGS. I. PR ION TO COVERING STRUCTURAL MEMBERS (READY FOR LATH OR FINISN COVERINGI, S. FINAL INSPECTION BEFORE AYYNUVEU rl/Nry MVO( OC NCIAINCU VN JUtl ANU IHIO CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- QUIRED, SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE APPLICABLa Ycrnnnl a' PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING AND MECHANICAL INSTALLATIONS. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 HEATING INSPECTING APPROVALS REFRIGERATION INSPECTION APPROVALS I I OTHER 2 2 WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION 11 INSPECTIONS INDICATED ON THIS CARD INSPECTOR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SM MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE OR WRITTEN NOTIFICATION. T-02-140 ' TOWN OF YARHDOTH . 1. BUILDING PERMIT '�-�TE April 4. 2002 'A APPLICANT-FhUip FUtten ADDRESS / FIELD COPY`, •off- �a z y�y% PERMIT NO. B-02-822 .A e.TEF nftzvn INO.) ISTREETI (CONTR'S LICENSE) demolition NUMBER OF PERMIT IO (_) STORY OWEWNG UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) 383 North Hain Street. SY 02664 ZONING R40 AT (LOCATION) DISTRICT INO.) (STREET) S' BETWEEN AND O )CROSS STREET) (CROSS STREET) p LOT SUBDIVISIOAOOII LOT BLOCK SIZE mBUILDING 15 TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION O Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION [ ITYPEI O REMARKS: reIDdVa1 of roof aver deck, colammn and deck_ AREA OR VOLUME ICUSIC/SQUARE FEET) OWNER. ADVa aL iarmm11L1 ADDRESS 1146 Route 28• PERMIT ESTIMATED COST $ FEE $ NIA i BUILDING DEFT. BY . INSPECTION RECORD DATE NOTE PROGRESS -CORRECTIONS AND REMARKS _ INSPECTOR 1 emv�- TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO 8 02-822 ISSUE DATE : _ _ _M�/02_ PROPOSED USE IE R M I T APPLICANT :-f0WI4oFvnAMb Tiif" """' - - - - JOB WEATHER CARD ADDRESS :1146 Route 28 ' ' PERMIT TO Demolish -'---------. AT (LOCATION) 00383NORTH MAIN ST = ZONING DISTRIC R-40 SUBDIVISION MAP LOT BLOCK 1100.1 BUILDING IS TO BE USE GROUP LOT SIZE CONST TYPE CONTR•S LICENSE 0 REMARKS remove roof over deck, columns and deck CONTR'S NAME AREA (SO FT) EST COST ($ 50.00 PERMIT FEE OWNER TOWN OFYARMOUTH ADDRESS 11146RMe28 BUILDING DEPT BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET. ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE. MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLUC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPUCANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE CONSTRUCTION WORK: 1) FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FINAL INSPECTION HAS BEEN MADE REQUIRED FOR ELECTRICAL FOOTINGS. 2)PRIOR TO COVERING STRUCTURAL WHERE A CERTIFICATE OF OCCUPANCY IS PLEWMBINO AND MECHANICAL MEMBERS (READY FOR LATH OR FINISH REQUITED, SUCH BUILDING SHALL NOT BE INSTALLATIONS. COVERING) 3) FINAL INSPECTION BEFORE OCCUPIED UNTIL FINAL INSPECTION HAS OCCUPANCY 4) REFER TO DETAILED INSPECTION BEEN MADE. "Ucrau c POST THIS CARD SO IT IS VISIBLE FROM STREET 2 2 \ / 2 3 GTHE}L I / z 3 4 5 WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INSPECTORS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION I-- 4 ors r c 'rs 5 BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN 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 is lyb " ��OR�fficeU11sse�e ,Only-�.... -, Permit No lJ�,,,,��Date - .. Permit Fee $ Deposit Rec'd. _$ t i 'Date Net Due Planning Board Inlamation Plan Type - Endorsement Dale Recording Date -- - 1 No. Assessors Department Information: ►+ac or map cot - 1.4 Pro party/Dimensions: Lot Area (sQ - Frontage (it) -..., lot Coverage Other :. - _ - This Section for Office Use Only- - -` Buildinq Permit Numbs . Date Issued: - Signature: O ?� - Build _ -.,. Date Certificate of Occupancy Is Is not required Section 1 - Site Information 1.1 Property Address: :373 Noe, ��,r ,�S y 12 Zoning Information: ,�7V ,V Zoning District . Proposed Use -- AIROW12 XFOX—M1/V /1 LG/T 1.3 Building Setbacks tft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided to Water Supply (M.QL. e. 40. S 54) Public X Private 1.5 Flood Zone Information: Comments: -. - - - - - Zone: - - BFE Section 2 -Property Ownership/Authorized Agent 2.1 Owner of Record: war—o> u� acre '7 S. ,f e . Name (print)./ Mailing Address, 979 23/ Signature !/ Telephone Telephone - 22 Authorized Agent f/0-1 EA �OA'D Name n Mailing Address: eh" 60,77S 7yo Signature - Telephone Section - Constructio rvi s 1.1 en Const n � Not Applicable ❑ License Number Address G OQ MARIPA Expiration Date Signature Telephone evL� 9- 15-99 1 of 4 OVER 3.2 Registered Home Company Name Contractor. Not Appritable Registration Number - Boration Date Telephone Section 4 = Workers' Compensation Insurance Affidavit (UG.L: Q 152 S 25C (6) j 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 .......... i . Section 5 Professional Design and Construction Services - for Buildings and Strictures Subject--- to Construction Control Pursuant to 780 CMR 116 (containing more than 35,(MO c.f. of enclosed space) . . Not Applicable A Name (Registrant): Registration Number Address - Expiration Date Signature Telephone Section 52 Reaistered Professional Enaineer(s) Name Area of Responsibility Address Signature - Telephone - Registration Number Emlratbn Date Nams Area of Responsibility Address Signature Telephone Registration Number Expiration Date Name Area of Responsibility Address Signature - Telephone Registration Number Expiration Date Name _ Area of Resportsroility Address Signature Telephone Registration Number Expiration Date Section Not Apprrcable Company Name - Person Responsible for Construction Aaaress f„ Signature Telephone 9-15-99 2 of 4 Section 6 - Description of Proposed Work (check alt applicable) New Construction ❑ (for muhiple famiy only) No. of Bedrooms (for multiple family only) No. of Bathrooms 6dsting Bldg. ❑ . Repair(s) ❑ 1 Alterations ❑ I Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: —�u pao �cc'tpec. C' e Or MY- l/ I-411OJ/ l*V / S A 00 L Ex 1rn/v6 915111411416 y Section 7 - Use Group and Construction Type Building Use Group (Check as applicapable) Construction Type A ASSEMBLY ❑ A-1 A-4 ❑ ❑ A-2 A-5 ❑ ❑ A-3 ❑ to 1 B ❑ ❑ B BUSINESS ❑ 2A 2B 2C ❑ ❑ ❑ E EDUCATIONAL ❑ F FACTORY ❑ F-1 ❑ F-2 ❑ H HIGHHAZARD ❑ 3A 3B ❑ ❑ I INSTITUTIONAL ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S STORAGE ❑ S-1 ❑ S-2 ❑ U UTILITY ❑ SPECIFY. M MIXED USE ❑ SPECIFY: S SPEC&USE ❑ SPECIFY: Complete this section if existing building undergoing renovations, additions and/or change in use. Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34 Section 8 Buildina Height and Area Building Area E)dsting Of applicable) Proposed Number of floors or stories Include basement levels Floor Area per Floor (sf) Total Area All Floors (sf) Total Height (ft) Situctural Engineering Structural Peer Review Required Yes ......... No )N -TO BE COMPLETED WHEN APPLIES FOR BUILDING PERMIT as Owner of the subject property, hereby authorize l7%�l �'�// gw/EiN /%&-rive o1Teat 1"aly/m 6! 5 to act on my behalf, in all matters rel tive to work authorized by this building permit application. Signature of Ow Date g_ 15-gg 3 of 4 OVER 1, vv "t" I , as Owner/Authorized Agent hereby declare thaf the statements and information on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name /j .. %��i��� 3�Zr� tea` Date Section 11= ESTIMATED CONSTRUCTION COSTS s Item Estimated Cost (Dollars) to be completed by permit applkmd t. ewlrnn0 2 Electrical 3. Phmbtq / Gas 4. MedWftal MAC) & Firs Protecfbn & Total -(1+2+3+4+5) 7. Total Satam Ft. Ow i runs&@oNo* Check Below ❑ Conservation -Commission Filing (d applicable) ❑ Old Iangs Highway & Historical Commission approval (d applicable) 9-15-99 4 of 4 rye+-._.. __ - _ .. -. - � „_ - �•.�-:�.,., __�L�4-X /�OiVD ,QG=C�t�C�-%7d/►/,cI,2C-y� ,erwyj1A po2CN PCOF eloulews itNO DE�� ��m/T TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACfIUS=02664-4451 Telephone (508) 998-2231. Ext 261 — Fax (508) 398-2965 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 383 A10ZN MA IV S771E6-T Work Address is to be disposed of at the following location: / "Mfyw IT"'oga Said disposal, site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. — &1�1 4& Signature of Applicant Permit No. 3 -Zo pe02, Date TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location: Number Owner of Property: Construction Supervisor: Address: Licensed Designee: . (If other than Supervisor) Name Name 2.15 Responsibility of each license holder. License No. Village License No. No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Anylicenseewho shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother 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 yu, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owners Agent Owner Q Agent Signature: Building Official Approval: The Commonwealth of Massachusetts Department of Industrial Accidents Alike011 MtISONs 600 Washington Street Boston, Mass 02111 Workers' Compensation Insurance Affidavit Applicant Information: Please]!HJJE Tedibh O 1 am a homeowner performing all work m)self. O 1 am a sole proprietor and hase no one working in any capacity O lam an employer pro%iding workers* compensation for my employees working on this job. comnany a d d re%s: ii1Y: ___ eheneN• insurince cu. policy 0 lam a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e the following workers' compensation polices: city* nhone N• - Failure to secure coverage as required ■oder Section 25A of MGL 152 eaa kad to dw imposiliu of criminal penalties of a One op to S1300m aadror one years' Imprisonment as well as civil penalties in the forma( a STOP WORK ORDER and alive of SI00.00 a day stalest me. 1 andentaed that a copy of this statement may be forwarded to the Office of Investigations or the DIA for coverage verification. I do hereby certify under the pains and prna/ties of perjury that the information provided above Is true and rorreet Signature Date Print name Phone N official use only do not urile in this area to be completed by city or town official city or town: YARMOOT11 Cl cheek if immediate response is required contact person: permlN{teeu N nBuilding Department DUeensiog Board 261 OSelectmen's Office pHealth Department phoneN;_ (508) 398—Z231 eat. mother I,r. 3,44 mil Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers 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 emphtyer is defined as an individual. partnership, association. corporation or other legal entity, or any two or more of the foregoing en=aged in a joint enterprise. and including the legal representatives of a deceased employer, or the receiver or trustee ;fan 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 dw ellina house of another who employs persons to do maintenance , construction or repair work on such dwelling house or kin the Grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. NIGL chapter l5_ section _5 als.1 states that even state or local licensing agency shall withhold the issuance or renewal of n 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 supply ing 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 2Md2viL 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 tlnce d Imstlll>ttl�sis 600 Washington Street Boston, Ma. 02111 fax 0: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 TOWN OF YARMOUTH Building Department = Town Hall Yarmouth, MA 02664 (508) 398.2231 ext261 BBUILDING PERMIT APPLICATION RECEIPT Temp Permit No.: T-02-140 Applicant Name: Philip Whitten Location: 00383 NORTH MAIN ST Owner's Name: TOWN OF YARMOUTH Owner's Addres 1146 Route 28 South Yarmou MA 02664 Owner's Telephone: (OFFICE USE ONLY Recorded By. k: Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 3126/02 Issue Date: Expiration Date Comments: remove roof over deck, columns and deck This Is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official Building Permit will be Issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee. Date Printed: 3/28/02 %off-�y0 TOWN OF YARMOUTH BUILDING DEPARTMENT Building Site Location: Proposed Improvement: Address: The Builc applicable departments. BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTIAL SHEET No: _Lot No: J RESIDENTIAL AND/OR COMMERCIAL BUILDING lion to the following WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A INDUSTRIAL AND/OR COMMERCIAL PERMITS 3. WIRING INSPECTOR: DATE: N/A 6. PLUMBING INSPECTOR DATE: N/A: 7. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: W6ioe0npy—BeMm9Dept- Ydlow Copy— Heabb DcM - Pmk Copy— Eogmeamg DWL - GoldawW-Fue DeplCoawvmtioo "?- off-iy0 TOWN OF YARMOUTH ( L130f BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTIAL SHEET Building Site Location: -3y 3 2I.ruth I Proposed Improvement: Address: Gt�?�tt "Whl Map No: /Z Lot No: / Filed: �i l The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. " FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: 1. WATER DEPARTMENT: �( DATE: 03—,2 d N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: 4. HEALTH DEPARTMENT: DATE: N/A 3. WIRING INSPECTOR: 6. PLUMBING INSPECTOR: DATE: 7. FIRE DEPARTMENT: PLEASE NOTE COMMENTS: RECEIPT OF COPY: Wbdecopy-BuBdingDepL- G'a wpy-WatcDepL - YcIlawCopy -HalthDept. - fi&Copy-EngummgDepL - Goldm�od.FoeMoComavatim Secpwtis-orroT . - worktdiexdraps} :-;:'—, - - _- New Cprmbucdon _❑ -(for murdpie family only) No. of Bedrooms (for mutople famey only) No. of Bathrooms Existing Bldg. ❑ t Repair(s)'o ,., ;Abratiorls ❑ Addition ❑ AccessoryBldg.:❑ Type- Demolition ' ^Other Specify Brief Description of Proposed Wolic jS el- _ .. - Section T - UsaGr6toand C rti T- Buildhg Use Group (Check as applicapable) - , Construction Type A ASSEMBLY ❑ - A-1 ❑ A-2 ❑ A3 ❑ A-4 ❑ AJa ❑ to ❑ 1B ❑ B BUSINESS ❑ 2A ❑ . -- _. 2B . ❑ - 2C ❑ E EDUCATIONAL ❑ - F FACTORY ❑ F-1 ❑ F-2 ❑ - H HIGH HAZARD ❑ . - - aA ❑ _ 3B ❑ I INSTrrunONAL ❑ - Fl ❑ .1-2 ❑ -.- t3 ❑ M YERCHANTILE ❑ - - - 4 ❑ - R RESIDENTIAL ❑ R-1 ❑ We ❑ - R3 (3- — _ _.. - SA ❑ - -- SB ❑ S STORAGE ❑ S-1 ❑ S-2 ❑ - u UT3fTY ❑ SPECIFY. SPECIFY. - - SPECIFy. M WED USE ❑ S SPECIAL USE ❑' C�OrllpletB it'�S�Oti�` . -. -.- g1�01r1g`rCnOVl�iOflS:O(1�1diOr`�laRgB'1rt'USf'� :. Existing use Gralp: ExMM Hazard Index 780 CUR 34 Proposed use Group. Proposed Hazard Index 780 CUR 34 SectimS Building HWWafidArea Bulding Area Existing Of apdkable) Proposed N miber of eoom or abrles - kvI de bssenbrt levels FbmMea per Fbar (sry Total Area An Floors (sf) Total Height (it) SecdOn`9'='ufRUG7I�R _ f 780CMR110.11)7 I IndePeridert Strwheal Ergin wft Smxtxd Peer Review RMAred We _..._... No .».._.» SEGTION.tOafi Et , TO BE- MEI'M WHEN.° ONR+IEA'671GE]ri1'€�i2L'j]►iTRAfL07iAPP_L1l=5SFOFl Bii(CIAfVGPEF�iA1T ) P-OgCver C L / W TVIV4 J, 9 . ZTW A 901 - , as Owner of the subject property, hereby authorize ---�,y/L/� r'l/y"fffaj 9/4evvLmjftiCF'% 6�5 to act on my behalf, In all matters rel five to work authorized by this building permit application. Sipnahxe of Date 9-15-99 3 of 4 OVER 0 tt is f CW-M 161WIM6 ,P.En1eII& Qo2CN A7DF C�ocv4'IuS Map 1we y J-FOc-� ��m�T TOWN OF YARMOUTH 09-/L%O BUILDING DEPARTNIENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTIAL SHEET Building Site Location Proposed Improvement: No:1O-Lot No: J The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlards, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: �11 DEFFi�I,r J. . WIRING INSPECTOR DATE: N/A 6. PLUMBING INSPECTOR: DATE: N/A 7. FIRE DEPARTMENT: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Whit copy—Buildwg Dept- Yeaow Copy —Huhh Dept - Pink Copy— Fa8bwm6 Drat - Goldenod-Fue DWt Cm9em6 n Section8=..iptforfo€Proposed:WdtfC(etledcaftappticabk} ;.. _ -- - . New Cdnsbuction - (3 1 -(for mulble famiy only) No. of Bedrooms (for mumple bm2y only) No. of Bathrooms — EldstlnpBldg. Q: Repair(s),U Alterations ❑ I Addition ❑ Accessory Bldg. ❑ Type Demolition- Other - Specify: Brief Description of Proposed Work r afiL&& Buildelg Use Group (Chedc as applicapable) Constriction Type A ASSEMBLY ❑ . - A-1 A4 ❑ ❑ A-2 A3 ❑ ❑ A-3 ❑ 1A 1B ❑ ❑ B BUSINESS ❑ 2A - 2B 2C ❑ . ❑ ❑ E EDUCATIONAL ❑ - - - - F FACTORY ❑ F-1 ❑ - F-2 ❑ - H HIGH HAZARD ❑ - - 3A 3B ❑ ❑ I INSTrTVnONAL ❑ 1.1 ❑ 1-2 ❑ - 1-3 ❑ M MERCHANTfLE ❑ -- _. - - - -- - 4 - ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ - R3 ❑ - -SA -- -. SB Q ❑ S STORAGE ❑ S-1 ❑ S-2 ❑ U UTIUTY ❑ SPECIFY: SPECIFY: SPECIFY: - - M MD®USE ❑ 8 SPECIALUSE ❑. :.omlpiete th"s 5ei�orT if 'boil SIIldelgDlrlg. renovdtidrLsa�itxlsandiOt=dlaageitt»e. c.Idsting Use Group: Proposed Use Group: Existing Hazard Index 780 CA1R 34 Proposed Hazard Wax 780 CMR 34 NunEer of Boom or stories Floor Area per Floor (sr) Total Area All Floors Total Hefaht (ft) I Indepmdem saucUlaf En&me ft SlucNal Peer Re0ew R"Ared Yes -- NO.---.- I i �fiE+N 7 (_-GHWT9A10 J/�L . 7-09W M1177/1V • as Owner of the subject property, hereby authorize Plll u� �/l�� OI&W P405tl�lVM65 to act on my behalf, In all matters relative to work authorized by this building permit apprication. sigrraltxe of Date 9-15-99 3 of 4 OVER ) 0O ,QG CAtr- -77d� ►cII74r7S tG �10��f1 Q02CN �F C'o/�n�.uS An Doe . Enrrc-nie"-6 fcvc fCfm17 v� TOWN OF YARMOUTH Application for a Permit to Build No. �337 70 �- UPON FINAL APPROVAL J`1171W 4' IC," MAP 90 LOT '14- i FEE MUST ACCOMPANY THIS APPLICATION. (74JA4-) DATE /Z The undersigned hereby applies for a permit to build I�%9' according to the following specifications /� 1. Name of property owner `rQLQy 4 Yjl4ff,, K� �r�`I•;�o1'nJ FlAX L, s/Tef..3y u3 larfasy Address Ilk kqoiLh 2g 5(k# VL A-,JI.. AA oz6611 2. Name of Architect (if any) 3'H 3. Name of builder-10 if MZ 0;A r acfs 4. License No. 059939 Tel. WO 5. Name of Mason Address 6 License No. Tel. 7. Construction address _ p4 5; 1. �h,,Ad u.fi r /hk Oz66y Flood District 8. Date of subdivision Approval plain zone Zone 9. Private dwelling ❑ Estimated Cost 10. Multifamily ❑ -41'a,300'0 11. Commercial ❑ s® 12■ a 141 12.Other ❑ 13. No. of stories 0 14. Foundation — Full ❑ Half ❑ Crawl ❑ Slab 129 15. Materials — Wood ® Cement ❑ Other ❑ 16. Type of heat — Oil ❑ Gas ❑ Electric ❑ Other ❑ 17. Garage —1 ❑ 2 ❑ oz660 DO NOT WRITE IN THIS SPACE Type of roomNo. Kitchen i 1, )/ Dining Rm. l� C Living Rm. 4 Bed Rm. Bath Deck Family Rm. II Sun room 18. Swimming pool - Size Garage 19. Storage shed —Size lZ ,114, Shed 12■ a 141 1 20. Stove — Wood ❑ Coal ❑ Alterations I 21. Size of lot: No. of feet front No. of feet rear No. of feet deep 11 22. Size of building. No. of feet front IT No. of feet side ►_' No. of feet rear 23. Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from line or street From rear lot line Side line 25. H.I.C.R. No. LOT RELEASED BY PLANNING BOARD Date Signature Addre BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT': I JOB LOCATION: 383 NORTH MAIN STREET SOUTH YARMOUTHMASS 02664 NUMBER STREET VILLAGE OWNER OF PROPERTY: TOWN OF YARMOUTH RECREATION CONSTRUCTION SUPERVISOR: THOMAS F. BUTKOWSRY 059939 398-2231 NAME LICENSE NO. PHO`�E N0. ADDRESS: 1054 MAIN STREET, CHATHAM. MASS. 02633 LICENSED DESIGNEE: LICENSE NO. (IF OTHER THAN SUPERVISOR) NAME 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 i 2.15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION, ALTERATION, REPAIR. REMOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDINGiI. 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. I 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 REG'U'LITIONS AND ANY PROCEDURES, AS AMENDED, SHALL 3E SUBJECT TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. 2.16. ALL BUILDING PERMIT APPLICATIONS SHALL CONTAIN THE NAME. SIGNATURE AND LICENSE :UMBER 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,'tTHE 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 DEPART`.D;NT• I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS FOR LICENSING C011- STRUCTION SUPERVISORS IN ACCORDANCE VITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERST?_:: 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 MGLCh.152 Yes 0 No 0 It you have checked ves. please indicate the type c average by checking the ap:rcprtate box. A liability Insurance pcticy O Daher type of :ndernnity ❑ 8ond O OWNER'S INSURANCE WANE am aware that the ucensee dc- rot have the insurance coverage required �/ apt' 152 of the s G Ns, am U`at my signature cn t:s pemut iation waives this requirement- 7 Check one - loft Owner0 Agent SIGNATURE: /��%� �UILDING OFFICIAL APPROVAL The Commonwealth ojMassaehusetts Department of Industrial Accidents OIAce 911/trttstlosl US 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance AMd2vit Applicant information: Ple>tie�RiN7'TedGhhr 1 e• . • . i. . a V lie . O 1 am a homeowner performing all work myself. O 1 am a sole proprietor acd have no one svorkine in any capacity lam an employer proN iding workers* compensation for my employees working on this job. murance co. policy 0 ® I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who have the followinc workers- ;ompensation polices: address, RO anent U210" Raven may^ r��—�n� J 111A OZtoC�D nhene 0, 760- Wfe insurance co eeliev P company name• Failure to secure coverage as required under Section 25A of MGL 152 can lend to the imposition of erimiut penalties sf■ not up to 3i.5m ae anwor one years' imprisoomeat as well as civil penalties in the form of a S70r WORK ORDER sod a Bee of SI00.00 a day stalest me. 1 ndenund that a copy of this statement may be forwarded to the Me of Investigations of the DIA for mode veriBcadoo. t do hereby certify Print name official use oniv oJperJury that the Information prodded above is true and correct late �d z/gs ll "1. Ii ]?ULfed;d,0 PhoneM�!�fl�,�98-Z2�/Grjci86 do not write in this area to be completed by city or town official city or tow": YARMODTQ Cl check if immediate response is required contact person: permitAiceuse a nBuilding Department ❑IJcensing Board 261 ❑Selectmen's Office ❑lltalth Department phonea:_ (508) 398-2231 ext. mother I.,.nea Y45 rlAl 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 indi% idual. 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 %ho 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 emplo%er. NIGL chapter I : _ section also states that even state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant w ho has not produced acceptable evidence of compliance with the insurance coverage required. Additional]%. 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. pplicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and suppl\ ing 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 affidav it should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation 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 matte. 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 Mice of Imstlladen 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 cit. 406, 409 or 375 � II6aC00 jK -a ' � �� a .. ': •.�� _. ._ _�,. -. _ '. BUILDING PERMIT APPLICATION SIGN OFF TOWN OF YARMOUTH APPLICANT: BUILDING PERMIT /: ADDRESS: 1146 ROUTE 28, SO. YARMOUTH TELE. NO.: 398-2231 DATE FILED: BLDG. SITE LOCATION:383 NO. MAIN STREET. MAP/: 79 LOT/: a-4 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: y RESIDENTIAL AND/OR COMMERCIAL BUILDING i WAM DEPARTMENT: DETERMINES COMPLIANCE OF WATER AVAILABILITY. ENGINEERING DEPARTMENT: DETE92EOUS COMPLIANCE FOR PARKING AND DRAINAGE. CONSERVATION COMMISSION: DETERMINES COMPLIANCE TO WETLANDS ACTS, I.E.: IF LOT(S) BORDER ANY TYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS,' MARSH LARD, ETC. HEALTH DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS. I.E.: REQUIRE- MENTS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES. FIRE DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REQUIBEIMM FOR PERSONAL. SAFETY, PROPERTY PROTECTION. I.E.. SMOKE DETECTORS, SPR]BII.F.R SYSTEMS. ETC. ' THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR ISSUING THE REQUIRED BUILDING PERMIT: REVIEWED BY: 1. WATER DEPARTMENT DATE: N/A: 2. ENGINEERING DEP V DATE: N/A: 3. CONSERVATION:DATE: 5 = 9 N/A: 4. HEALTH DEPARTMENT'- c DATE: T-NIA: 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. A SIGNED RECEIPT FROM THE DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING PERMIT. COMMENTS: i BLM 89 BUSINESS: FREE STANDING: SrZE• •. ATTACHED: SQE: RUNNING FC+OTAGE: nTu�n. SIGN PERMITNp �fC_ S•jp•j SIGN ERECTED: SHEET KO—. D o VARIANCE: — -11 r J. a Gib APPLICA11Ow 10 ERLCI AI:U I:AIMA1N SIGN _,Yar=uth__Rar _jC=iSS_OD_..__.__ TYPE Of COw51 Rucl low ___WoQdLRoggd1 WAIL ............. �:_................. ... ___._-� rREE SIANDwG OR ATIACHLD_Free_ Standing:__;_ 10 THE INSPECIOR Ol BUILDINGS. Under chapter 807 stab building code utide 14: Tht undrrsionrd hrtebt• apples foe a rc-.mh accoiding�t�ortihr tto1llov+Aing information; Location LL`�VWt�i YYY.fIYMIY LYMY•�1�ft•�1J1L2�'u:Z 11.1 ''� ��.. Proposed Ust mill irinal RerrPatinn - Flax Pnnd R L tinn Aug,,,,,,.._...--._..-..• ZonincDtsltta. R-iF ---- --- v..r�...,u...........................y.....................L............ L�1•n`-e Name of o.•.,,t- Town of Yarmouth Name of 6wldE• Yarmouth Park i)artmgj. D:agtart. of Lot and Sro•t will. Mn.rnsiots to bE Piaccd Thercon. 7ow4 or ! ' 0 lover of 44iffi.itg t �Y \yatmNrd f`` lil�I' — NKI'l( MAIM STMT -; Im i 1 50" -� FLAX PoND REGREAT101J A2Efl irz *M 4X4 -� GRoo,u D 1 hrtebl sour to conform to al; thr RAes and RecUla1tons of the Town of Yarmouth regarding the above construct. ion. 1 furn,rt aOreE that tfin sto•. v411 not bE alined• added to. of chanted in any teary until anew permit has been atanted. Tttt numtx•: of hers primer will lr affixed to the lion in no lessthan%- numbers. Namr—l�l/1A.C.�.� �• �i r+ r /� �94llL<'L ,JW_.�fs i TOWN OF YARMOUTH Application for a Permit to Build No. 3/ � UPON FINAL APPROVAL v -'7" MAP 79 L ems' FEE MUST ACCOMPANY THIS APPLICATION. DATE 1 The undersigned hereby applies for a permit to build % according to the following specifications 1. Name of property owner TOWN of YABMOUTH (RECREATION DEPT.) Tel 398-2231 Address 1146 ROUTE 28, SOUTH YARMOUTH, MASS. 02664 2. Name of Architect(if any) Tel. 3. Name of builder THE F. RUTcoWsKY Address 1054 MAIN STREET, CHATHAM, MA. 02633 4. License No. 059939 Tel. 945-2048 I 5. Name of Mason Address JI 6. License No, 7. Construction address 383 8. Date of subdivision Approval Tel. 17S,T17V-1W7T7V 9. Private dwelling ❑ Estimated Cost 10. Multifamily ❑ .500, o 0 11. Commercial ❑ RooF 12.Other ❑ 13. No. of stories 0 14. Foundation — Full ❑ Half ❑ Crawl ❑ Slab ❑ 15. Materials — Wood ❑ Cement ❑ Other ❑ 16. Type of heat — Oil ❑ Gas ❑ Electric ❑ Other ❑ 17.Garage —1 ❑ 20 18. Swimming pool - Size _ 19. Storage shed — Size 20. Stove — Wood ❑ Coal ❑ 21. Size of lot: No. of feet front 22. Size of building. No. of feet front _ 23. Distance from nearest building: Front 24. Distance back from line or street 25. H.I.C.R. No. LOT RELEASED BY zone %� Zone `_ DO NOT WRITE IN THIS SPACE I Tvpe of room I No. No. of feet rear Signature pZ,S I uC% Dining Rm. ;� Living Rm. Bed Rm. Bath G Deck ly. Closed porct Family Rm. 1 Sun room i No. of feet side Ft. side From rear lot line Shed i Alterations ! _ No. of feet deep No. of feet rear Ft. side Rear Side line PLANNING BOARD Date Address 1054 MAIN STREET CHATHAM. MASS. 02633 1 BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: JOB LOCATION: 383 NORTH MAIN STREET. SOUTH YARMOUTH. MASS. 02664 U NUMBER STREET VILLAGE OWNER OF PROPERTY: - TOWN OF YARMOUTH. (RECREATIONS DEPT.) CONSTRUCTION SUPERVISOR: THOMA•S F. BUTEOWSKY• 0599939 945-2048 NAME LICENSE NO. PHONE NO. ADDRESS: 1054 MAIN STREET, CHATHAM, MASS. 02633 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 LA,S 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 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. I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND.REGULATIONS FOR LICENSING CON• STRUCTION SUPERVISORS IN ACCORDANCE w'ITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTAN; THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. 9 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent whleh meets the requirements of MGL Yes ❑ No ❑ If you have checked=, please indicate the type overage by checking the at ;rcprtate box A liability Insurance pCicy ❑ O:her type cf :idemndy ❑ Band ❑ OWNER'S INSURANCE WAIVER: I am aware that the acensee doei not have the Insurance coverage required :y Ctapter152 of the Mail: General Laws, and ttat my signature on uas permit zaplication wanes this requirement - Check one: gnatwe of C.ner or owiat a ysnt - .I Owner❑ Agent ❑ SIGNATURE: 1.;,� 12MBUILDING OFFICIAL APPROVAL The Commonwealth ofMassaehusetis Department of Industrial Accidents OfAee 011WITsMS&ONS 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant information: PlessmiNI'Sea t name* TOWN OF YARMOUTH (RECREATION DIRT.) location 1146 ROUTE 28, SOUTH YARMOUTH, MASS. 02664 eih. phone 0 398-2231 0 1 am a homeowner performing all work myself. 0 1 am a sole proprietor =rd ha%e no one working in any capacity Xg I am an employer pro%iding workers' compensation for my employees working on this job. [Ih'• phone a• polity 0 0 I am a sole proprietor. _eneral contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e the following workers' ;ompensation polices: company name* [ih• phone M• insurance Co.policy M Failure Insecure coverage as required coder Section 25A of MGL 152 ran lead m tie imposition of erimiaai peaaiaes of It One rap to a1.SNAa aowoe one years' imprisonment as well as civil penalties In the form of a STOP WORK ORDER sod a flat of f100.00 a day against me. I uderstaod that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verillcadoo. 1 do hereby certify under thepoins and penalties ojpedury that the information provided above is true and correct Signature Due Print name Phone I official use only do not .rite in this area to be completed by city or town affleAl i city or town: YARMOUTH _ permithicense a ClBuildiog Department C3Ucensiot Board O check if Immediate response is required 261 OSeleetmen's Office ❑Health Department contact person: phones, (508) 398-2231 ext. ri0ther (, .� 3•e5 r1A1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their enmploy ees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An ernplor•er is defined as an individual. partnership, association, corporation or other legal entity, or any two or more of the forecoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance. construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. NIGL chapter 1: =section 23 also states that even state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth ror any applicant who has not produced acceptable evidence of compliance with the Insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ham 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 supply ing 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 Jate the affidavit. The affida%it should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation 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 afUdavits 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 ffllce d IMS01398n 600 Washington Street Boston, Ma. 02111 fax N: (617) 727-7749 phone 0: (617) 727.4900 ext. 406, 409 or 375 . ON:. The Commonwealth of Massachlfsetis Deparfmrnt of ptrbhe W-ty } - • -�•.. 4'.-e:A:%tF'i�F.' nr-.�L�q+cr • .:y.,t .•. nOARD OF FlfiE t'[1EVEllTO�AEGULATIOAS�EZ7;CMR`iL�O; ]/9ai'f. �':'�Y`r'�;'�"'w'?"�'o. . • r ..e ►lass) . APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AD es.l b be Pni-fe..d In afce'&- a W11h the Maaeac►wela 0c tzkal Code, SIT C71R I :00 trl,FASE rxI1TT ix nm ox IIPP ALL I1rrcm=loH) Date f City�c= Tow of 4n9+ntm< :::f ...., .; `zc`tt'e'Yrrpeeio11�`IMAQ f �J"The undersig ed sppl[es for a permit to perform the electrical work described Delocation (street L Bucher)383 NORTH MAIN STREET (FLAX POND) 0 4 2002 Owner or Teoaee m-raht nv Vntaa-uvns LI Ovaet's Address 11d/. R(1T TPF 'lflV cf-v p+es v*Q`(()()'T[i By ' -. t ... - -✓eS� .. lq Is this`retmie eosjunWoo. with a Wilding perhits 7es -❑ Mk ❑ (Check Appropriate Boz) Purpose Of IIutldint Ut11ltyAotharimciam a..0. ., VO._.J-a&5 l,e;'r 14..r7 - 2tistlnt Setvica' A-ps / ve Voltz Or[wQ Undtrd ❑ 1b. of Haters xe'i Serc[ee flops / voles Overhead tJ VQdird ❑ it*. of M ters Number of Feeders and A-pdelty f11T ri TP ON POT , 74/3 location and xlenra of Proposed Electrical Stone ( REPLACE-POII.E _2_& TRESFER SINGLE PRIMARY .TO_NEW POLE xo. of Litbttat Outlets M. of Rot Tubs No. of Transformers TOOM No, of L[thtLot Fixtures Sv[aatnt Pool Above ❑ m� ❑ stud. rnd. Ceaeratars I:VA xo. of ReNptacle outlets No. or Oil Burners N. of rgernoy oL h IIatee Un tit S L xo. or Sti'ttch Outlets No. of Caa Lurners TUX AIMS No. of Panes , No. of Detaction and Init4tlat Devices Mo. of Ranges No, of Air Cond. teal go. of Disposals $a. of .eat Satal Total a RV Bo. of Sounding Devices Detection///Somw xa, of Dishwashers Spacehrea Ustiat XW nt Devices Local❑ huteipaI cOcber go. or Dryers Beating Devices IV Ceeneetia+ SO. Of Sia ter Rested M31 S{f s anvoltace Ballasts No. lfjdt0 Massage Tubs No, of Motors Total It? v.ae..: 3ud-�� the rcgattesata of ItassetbaseturGeatr[Slivs ee Polity lxluding Coopltted Operations Coverage or is aubstane[al ea�N0I pacesmhittted valid proof of same to this office. TESE Bo ❑ I e el+eckea T15, pleue lydicate the type of eoveraga by checking the appropriate box. IB51WCE ® Z0.1M ❑ enn ❑ (please Specify) GENERAL ACCIDENT INSURANCE a 07/31/02 EstL.ated Taloe of Electrical work S ptratlon '+te Nark to Start-/1/02 Impaction Date Requested/ Noun, rinal Signed under the peoaltles of perjury[ "M RAC RRTT T V RTYr-- [TTf sT fY-" ' T LIC. N0. Licensee_ JAMES J. REILLY Sitn+ture�ikA tIC. No, EL 16666—A a AA- ... 1In nrn nrvme v=I on .Yve,ef_ veewu-x OU11CX'S 1NSUWCt VAIVn: I as aware that the Licenses does two ha a ths.tnel. mom oSver3ags erg to ataatiat equivalent as rrgolted hT Massach"etta Caneral vaf and t t or signature on this permit application valves this regvlrenent. Amer Agent (please cheek ant) Sfanaeurp of G.—e — a.... Ielephone No, PERMIT rrr. It nX \13 G,.I'm I inV S-`Z-11 er " - MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING Cltyrrown. South--____---�, MA. Date:; 10/2-9/^2010 'Permit# �/1� ire Z t Building Location: 383 North Main Street Owners Name.. r- I Town of Yarmoutut h PType of Occupa ommercial j Educational ❑ Industrial u Institutional Residential New: er . n-J Renovation:71 Replacement 0 Plans Submitted: Yes � No (0) �sn,■ o i h LL ' 10 zd t0> Y �-j yF N =D. lY Y to N y Q y V'lY Z 3 N= o) ? F' W? O Z N N y CLL in 0� in 0 Q CO Q W W N J J? lY LL X NN Q �J N a. X Q. Q 2 W W W IJ P J CC Q 'i IY Q Q N r? -j Q 0 t 7> O= 0 Q r 0 0 0 Q M to o o IL 0 x x g g X rn co 1- D 3 3 3 o Check One Only Certificate # Installing Company Name:': Robert W. Irvine &Sons Inc. Corporation 2531 C Address: [14.7__BlossomStreet 9C1tyrrown7w:�_0State: FMAJ---- IPartnership Business Tel: 781-581-0464—� Fax: 781-581-2860 Finn/Company I r --� Name of Licensed Plumber. William Michael Gillespie INSURANCE COVERAGE: I have a current liability Insurance pollcy or Its substantial equivalent which meets the requirements of MGL Ch.142 Yes�D,(No�] If you have checked Yes, please Indicate the type of coverage by checking the appropriate box below. A liability Insurance policy M/ Other type of Indemnity u Bond L] OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement rC_h�eIck One Only Owner u Agent Signature of Owner or Owners Aoent 1 hereby certify that all of the details and Information I have submitted (or entered) regarding this application aretrue and accurate to the best of my Knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General laws. By; Type of License: Tale, _ _ � Plumber ��� Signature of Licensed Plumber � -�--- � - Master l.: C'h'rrowni Journeyman License Number: 10865 •eoemren'ncc. eE ice raw v� SUP61 TOWN OF YARMOUTH Building Department BUILDING (F. _ _ _ _ _ - (508) 398-2231 ext.1261 PERMIT NO 6-14-459:-.--..-- PERMIT ISSUE DATE ; _ 9/26i2013 - : PROPOSED USE ; APPLICANT DamonBumAill - JOB WEATHER CARD PERMIT TO Accessory Structure: I AT (LOCATION) 10031DUPONTAVE I ZONING DISTRICTEE Bldg. Type: Commercial I SUBDIVISION MAP LOT BLOCK 1100.1 LOT SIZE BUILDING IS TO BE: CONST TYPE I USE GROUP construct wood frame utility building for septic control equipment as per plans submitted. REMARKS AREA (SO FT) EST COST ($ 0644.975.00 1 EF�•1R FE (S) OWNER OWN OF YARMOUTH BUILDING DEPT BY ADDRESS 1148 Route 28 South Yarmouth I MA 102664 INSPECTION RECORD CONTRACTOR LICENSE Burotdlll, Daman 771 P.O. Box 153=4 Great Waste — oa Harwich MA 02645 7748360993 PHONE 15083982231 FIELD COPY .. Correctionsii.l „i i , �..a l � ..G GrZM15 81!pGen - Portal Home Town of Yarmouth Template [Building Dept) Slipsheet Identifier [sg29326] Document Category Building Permits Map -Block Number 100.1 Street Number 0031 Street Name DUPONT AVE Department Building Parcel ID 12488 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2015-06-25 - 14:56 ItVJAaser1khe12G1pGW V1