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HomeMy WebLinkAboutBuilding Permitsof r TOWN OFYARMOUTH Building Department BUILDING �!s _ _ . _ .. • _ _ . (508) 398.2231 ext.261 ._ PERMIT NO F6-04-1442 PERMIT ISSUE DATE ; • 6/25/2004 - ; PROPOSED USE _ _ . _ .. _ , • APPLICANT Marlon Gleason ............. • • ..... JOB WEATHER CARD PERMIT TO Addition AT (LOCATION) ZONING DISTRICTE0 Bldg. Type: Residential 100041ELUSCIR SUBDIVISION MAP LOT BLOCK 1133.23 BUILDING IS TO BE: CONST TYPE 6-B USE GROUP R-4 LOT SIZE CONTRACTOR patio as per plans dated 0&22/04. REMARKS AREA (SO FT) EST COST ($ $8; OWNER IMARION K GLEASON ADDRESS 385 Mass Ave. Arlington MA 02474 PERMIT FEE ($) $148.00 BUILDING DEPT BY LICENSE 0 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector -a -o y v oF'YgR,� ONE & TWO FAMILY ONLY - BUILDING PERMIT n 1 �_ C APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 0\111 p y Town of Yarmouth Building Department (,� NATTACHE 5 1146 Route 28 • Yarmouth, NIA 02664-4492 \,/ �f`'""•�'� Tcl: (508) 398-2231 x261 • Fax: (508) 398-0836 Office Use Only Planning Board Information Assessors Department Information: Permit No. • - ItMIBat4p 7 Type Map Lot dorsement Date Permit Fee $ /ij�$, ' Recording Date New Deposit Rec'd. $*15,00 Dates p 'flan No. 1.4 Property Dimensions: Net Due $/a3r it Ot�, Lot Area (sf) Frontage (ft) Lot Coverage Buildin Per Number• Date Issued: Signature: 6 �,a 11 Certificate of Occupancy Building Official Date is Is not required Section 1 - Site Information Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning Information: y/ E�c1s c/kCIc OY Zoning District Proposed Use 1.3 Building Setbacks fit) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L. c. 40. S 54) 1.5 Flood Zone Information: Comments: Public Private Zone: - BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: rY1 " f'olu K. GLE�sbr� Name (print) Signature 2.2 Authorized Agent: Name (print) Signature Telephone Section 3 - Construction Services 3.1 Licensed Construction Supervisor: Address 3.2 Registered Home Improvement Contractor: Company Name Address ,!5(Y5 /)I ass Mailing Address 7f/ - (P 571— Telephone Mailing Address Fax III I� , • �'' Ial � Not Applicable ZI License Number Expiration Date Not Applicable L License Number Expiration Date Signature Telephone 1 of 2 OVER a" . 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 t0 provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .......... No .,........ Section 5 - Description of Proposed Work (check all applicable) New Construction ❑ No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: Costs Section 6 - Estimated Construction Item Estimated Cost (Dollars) to be completed by permit applicant Check Below Conservation -Commission Filing (if applicable) --/ ® Old Kings Highway & Historical Commission approval (if applicable) 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & addrtlons) b0 - Section 7a - Owner Authorization - Owner's Agent or Contractor Applies To be Completed When for Building Permit it Aga f n N I< G L r= 4Sa (0 , as owner of the subject property hereby authorize %Y) I KC 1Y)E0 t% 1 R O S to act on my behalf, in all matters relative to work authorized by this building permit application. Qlt,t yaJ Kr. r, 17 -, -�0 0 Y ignature of Owner- Date Section 7b - Owner/Authorized Agent Declaration I, AAA to f K. 6G6—o , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. MARIoA) K GLERSon1 Print name ao V Signature of Owner/Agent Y" Date 9-15-99 2of 2 For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the `reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pro -existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: Est. Cost Address of Work Owner Name: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date' Owner Name The Commonwealth ojMassachusetts Department of Industrial accidents exce811JUSI/psl NS 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant Informaiion: PfeasrEHUVTTettfl& CiIN phone 0 1 am a homeowner performing all work myself. 0 1 am a sole proprietor ha%e no one working in any capacity I am an employer prop iding workers' compensation for my employees working on this job. company name: phone N: insurince co. Qolicy N Cj I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who have the follow in- workers• compensation polices: company n+me• addr ee• sip • Qhone q- insur•ancc co Qoliey q Failure to secure coverage as required under Section 25A of MGL 152 cam lad to the imposition of erimlaal penalties of a flat up to 51.MAO and/or one years' Imprisonment as well as civil penalties io the form of a STOP WORK ORDER and a floe of S100.00 a day against me. I maderstaad that a copy of this statement maybe forwarded to the Once of Investigations of the DIA for coverage verifleatioa. t do hereby certify under the pains and penalties of perjury that the information provided above Ls true and eorred. Signature Daze Print name Phone 0 Official use only do not %rite in this area to be completed by city or town official city or town: YARMOUTH ❑ check if immediate response is required permit/licenst 0 0Building Department ❑Liceosiog Board 261 ❑Stleetmen's Office no% 398-2231 ❑Ilalth Department phone #.. _ %5 _ ezt- n01htr contact person: Ironed 7•95 v1At Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their entplo%ees. As quoted from the "la%%`. an employee is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An enrphover is defined as an individual. partnership, association. corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual . partnership. association or other legal entity, employing employees. However the o%%ner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the daelling house of another %%ho employs persons to do maintenance , construction or repair work on such dwelling house or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. %lGI_ chapter 152 section =5 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 who has not produced acceptable evidence of compliance with the insurance coverage required. Additionalh. 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 haw e been presented to the contracting_ authority. Applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial .accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affdavits may be returned to the Department by mail or FAX unless other arrangements have been made. . The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Mce If to estl/itl0ot 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 260 PLEASE PRINT: DATE: /►'lay , ao o y JOB LOCATION: "HOMEOWNER" HOMEOWNER LICENSE EXEMPTION NAME STREET ADDRESS SECTION OF -/_ L// .. n NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS r :? R & h'14 S 5 4445 A'd G 0 ,PLIy97oA/ MA V 6,0y7u CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code Section 108.3.5.1) Definition of Homeowner: Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and / or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner" shall submit to the building official, on a form acceptable to the building official, that he / she shall be responsible for all such work performed under the building Wrmit. (Section 108.3.5.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE `7"/ a t" i(! w-., APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL CIL 142. Yes ❑ No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one• Signature of Owner or Owner's Agent Owner Agent ❑ hhomeownrlicexemp FA TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH NIASSACHUSETTS02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING c / N 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 pr{oposend work/demolition to be conducted at yz 4 � ) �1jw f�% / /` 0 of Work Address is to be disposed of at the following locati/-/hO U Y7� 11 - r g �� Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. Date i "TM Old King's Highway Regional Historic District CommiVi e - l �; l �TH in the Town of Yarmouth fora TOVA�! `� ` `} C R K CERTIFICATE OF APPROPRIATENESSM JUN 12 M 9: 4 S-'� ation is hereby made in triplicate, for the issuance of a Certificate of App idd� L6on 6 ipter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on drawings or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: 1. or Building Construction: p New Building Q Addiuon p Alteration Emb ate h'pe of builder O House 0 Garage 0 Commercial • p Other 2. Ext rior Painting: 17 3. Sigi s or Billboards: D New Sign 13 Endsting Sign p Repainting odstinrg sign 4. S p Fence O Wall p Flagpole p Other n p± ,r.e.d �"-l� TYPE I R PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK(/ ELU s 6 r dd ASSESSORS MAP NO. 133 o m t �o&1 k.. 9k ._ ASSESSORS LOT NO. ;P USE be used Check ADDRESS_jVL E&5 Grc(o t VAArno ►+,P54 TELEPHONE NO.,509 - �31,�Q -6-3*7 r 'OR CONTRACTOR Pn.t C� TELEPHONE NO—jig=►-,,LJ SHEET IN PACKET FOR ABUTTING OWNERS D DESCREMON OF PROPOSED WORK Give all particulars of wwk to be done including materials to case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if OKHC signer / t,&��— Owner�ontractor-Agent This Certificate is kreby f-alO�(,6xUA ,, Date `O/// O EWPORTAI'FT/ If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act D Please return to: Yarmouth OKHC District Committee Yarmouth Town Hall, 1146 Route 28, S. Yarmouth, MA 02664 ? A itr.!' fill TION (18" MAX. EXPOSED): CONCRETE/OTHER WALK WAY: SPECIFICATION SHEET (YARMOUTH OKHQ ^r:�f out the form in its entirety providing I INDICATE LANDSCAPING, EXTERIOR LIGHTING & M RIC ML&re TE VHOUSES 2M JUN 12 AM 9. 49 RECEIVED DRIVEWAY: TYPE & MATERIAL: STEPS (INDICATE BRICK/cud ENT/OTHER): (INDICATE BRICK/STUCCO/WOODFACED) MATERIAL: PITCH (7/12 MIN.) MAX EXP. )WS (GRILLES REQUIRED)—(WOOD/OTHER) fE SIZES IF NOT LISTED ON ELEVATIONS: (WOOD/OTHER) 3 SIZES AND STYLE IF NOT LISTED ON ELEVATIONS): (ALL WINDOWS & DOORS TRIMN ED WITH 1X4 / IX5) ►L OF TRIM: (WOOD, VINYL, ALUMINUM) !S (WOOD/VWYL) (PANELED/LOUVERED) i (WOOD/ALUMINM: DOORS: S12E & STYLE: WINDOWS & DOORS: E SIZES IF NOT LISTED ON ELVATIONS) JHTS: TYPE/SIZE: ; K / 0 )by Z 1 DECK: SUE: -0 F,a(zgnFp.j Poacpl v".j ) FENCING (MAX. HEIGHT 6): STYLE: LAYOUT & RUNNING FOOTAGE ON SITE PLAN) WING WALL: (P. .Z0FIELDST0 NCRETE INAPPROPRIATE) LAYOUT & RUNNING PLAN} rz(?i,►C SIGN (indicate size, style, colors) SIGN OST: (indicate size, style, color) COLOR: COLOR: - COLOR. COLOR: COLOR: COLOR: COLOR: COLOR COLOR: COLOR: - (1 COLORr COLOR: COLOR: COLOR: REV. :?-At^cw TOWN OF YARMOUTH , Building Department Town Hall Yarmouth, MA 02664 (508) 398.2231 axL261 BUILDING PERMIT APPLICATION RECEIPT Temp Permit No.: T-04-587 Applicant Name: Marion Gleason Location: 00041 ELLIS CIR Owner's Name: MARION K GLEASON Owner's Addres 385 Mass Ave. Arlington MA 02474 Owner's Telephone: (781) 641-0634 (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Cash ChkNo.: 0 Net Owed: ($25.00) Application Date: 5/18/2004 Issue Date: Expiration Date Comments: construct two decks and patio ZONING APPROVED L y - CJ/ 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: 6/15/2004 O •Yq�1Ai 3( c O H •un w S. fwq....- yC7 . 5�1 TOWN OF YARMOUTH �� BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Building Site Location: �� 7 i%Q Map No: 13.3 Lot No: a 3 Proposed Improvement: (`��_.? �1J� of ��1�� ter;- %' r��i ti Address: 3X., The Building Department will be responsible for assisting the applicant by applicable departments. S. dispatching your plans and or application to the following 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 System, Etc. ................................................................................................................................................... REVIEWED BY: WATER DEPARTMENT: DATE: 6 ? 6� N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: CONSERVATION: DATE: N/A HEALTH DEPARTMENT Y DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: Cq(j �, PLEASE NOTE N/A: ✓Zs QvIe£ >.y2a -�W£ SL£fLJf_r RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: White copy - BuddmB Dcpc - PWk copy - W&W Dept. - Ydlow Copy - Heahh Dcpt- - Pwk Copy - En8iiiecrin6 D� - Goldrmod - Fire DgLACouwvrtim I .. .........— - - LOT 26 yy� 0 AUG 23 PM 1 24.3' � - ��T �5.1 �'•• 70� Olf CB %V CB turr r AL iL ZL JUN 1 7 2004 / Yarmouth Wat�F L, AL RES. ZONE- "R40" This ORTGAGE INSPECTION Plan is Bank Us TOWN: ...REGISTRY OWNER: _CEQBGZJ_., DEED REF 14 -4 .4?.fi____ ____—_BUYER• V14Br1,m--. DATE:—7,12_41S3---------------- PLAN REF: _1d A_OEM I HEREBY CERT FY TO �� er SA NCS AN THAT THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS a PAUL SHOWN AND THAT ITS POSITION DOES CONFORM A. TO THE ZONING LAW SETBACK REQUIREMENTS OF THE TOWN OF BMOUTX AND THAT N0 Y�,` �e IT DOES_ NOT LIE WITHIN THE SPECIAL FLOOD HAZARD �cmisEo AREA AS SHOWN ON THE H.U.D..MAP DATED_ZM_/ __ is AREA �nllt~+.--ITt�IOtTVL�KT—TSfb �'��� eiiovry ►inn mn or itgwn raq IL IL Only FLOOD ZONE- "C" Ma------------------- ----------------------- _ SCALE:1 40 --- FT. YANKEE SURVEY CONSULTANTS 40B (SUITE 1) o INDUSTRY ROAD MARSTONS MILTS_ MIL 02648 TEL 428-0055 FAX 420-5553 mt, 24483 DCB . � r..7- .!,t ."ii,i", rw .j--Zp,-�,-,-, "i - �VI,,�.T.,."I­ 1-�1-1­410-�7�N.��­IIii�, -_ .-"-" "c-'_ �. . I 1, ��-7:'�.=T-.'-Ie-��-�!�-'--,Z�-��,-��z'%�.�r��'�" `I-"` " � _,..,C71�_�,�.-�� -,t_--_.."�..,:_. -,_.­,Im,..� - , .. " , , I O­ �­ �,, ,'�;: _-_,-,�,'iI4q.:A . - ­ ... '11, - -4,�, ,.VC �7.,,,�,�-K-''e..-,�i�-,�,,';t,k�.,:-. I ­1� --I-- �, I ., ­­, .1-r- � ,-,.&I.. II � �, .,. -;W III - � 4 --..� -.,. , I � " If, .1 ,- ­ .- � -- - I ,-,,, " . . ,� , I, 1. , I, .,­ . " , 1'� - - ­ , - I .. 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I . - . . � � . ,­ ��� I _,,� I . . lumow " Dew" ' ;:; Old King' ,Hh ay Regional Historic District ct CommiW419SOUTH C I ;nWeTown ofYarmouth for a TOWN CLERK ' CERTIFICATE OF APPROPRUWMSS M JUN 12 01 9= 8AP Application is hereby made in triplicate, for the issuance of a Certificate of AppmPIE>tlassWE6ebtion 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for. CHECK THAT APPLY: I. Exterior Building Construction : p New Building p Addition p Alteration Indicatz t)Pc of building: 13 Howse ❑ Garage 0 Commercial 0 Other 2. Exterior Painting: p 3. Signs or Billboards: p New Sign O Existing Sign 17 Repainting existing sign r- 4. Stnrmm p Fence p Wall p Flagpole p Other n_n-ito TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK �(/ ELL1 r r c-Id. ASSESSORS MAP NO. 133 OWNER iYi hQ t o tJ K. 7GL.t=A-s� ASSESSORS LOT NO. cZ? HOME ADDRESS/ !clfr5 Grdu �VAama 4=POV4 TELEPHONE NO.:: — 3LQ —,b3r! AGENT OR NO_J ,3 ADDRESS USE ATTACHED SHEET IN PACKET FOR ABUTTING OWNERS - • -- DETAILED DESCRIPTION OF PROPOSED WORK Give all particulars of work to be done including materials to be used Incase of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). Signed tg Sr /� Cl L�c�-- Owner-Contractor-Agent _Space below line for Committee use only. Received by OKHC Date 6,461 Check By APPROVED DISAPPROVED 13 provided in the Au. . Please return to: Yarmouth OKHC District Committee Yarmouth Town Hall, 1146 Route 28, S. Yarmouth, MA 02664 610ADT SPECIFICATION SHEET (YARMOUTH OKHQ Please fill out the form id its entirety providing ��i��re necessary. INDICATE LANDSCAPING, EXTERIOR LIGHTING & EL RI M ITE PLANS FOR NEW HOUSES ,/ CC �/ 2m3 Puri i 2 All9= u 9 ADDRESS: 6T I G ��i f re—lt RECEIVED FOUNDATION (180 MAX. EXPOSED): CONCRETE/OTHER DRIVEWAY: WALKWAY: STEPS (INDICATE BRICK/CEMENT/OTHER): SIDING TYPE & MATERIAL: COLOR: CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED) COLOR ROOF MATERIAL: PITCH (7112 MIN.) COLOR MAX EXP. WINDOWS (GRILLES REQUIRED)--(WOOD/OTHER) INDICATE SIZES IF NOT LISTED ON ELEVATIONS: DOORS (wowoTHER) (INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS): COLOR: 'PRIM: (ALL WINDOWS & DOORS TRMAED WITH 1X4 / IX5) COLOR: MATERIAL OF TRIM: (WOOD, VINYL, ALUMINUM SHUTTERS (WOODNINYL) (PANELEDALOUVERED) COLOR: - GUTTERS (WOOD/ALUMINUM: COLOR: GARAGE DOORS: SIZE & STYLE: COLOR: STORM WINDOWS & DOORS: COLOR: (INDICATE SIZES IF NOT LISTED ON ELVATIONS) SKYLIGHTS: TYPE/SIZE: � K / D F► amr-14J P00011 COLOR: �- WOOD DECK: SUE: py—F-v -0 Fr6 COLORe - WOOD FENCING (MAX HEIGHT 6): STYLE: COLOR: - (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) RETAINING WALL: (P. . OR FIELDSTONE . NCRETE INAPPROPRIATE) (SHOW LAYOUT & RUNNING P ,L - -s SIGNS: (indicate size, style colors) 'ZR LK ':'4-" i ( L COLOR: ,'� ARl.,O I ��. l SIGN POST: (indicate size, style, color) Y UTy C01,{;,f . . ! COLOR: KHRO ADDITIONAL INFORMATION: `•`•'�-.•_ REV. 12/02 '?m'jj(t)SP i 5� TOWN OF YARMOUTH -� �.I. BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Building Site Location: No: f 33 I.ot No: a? 3 Proposed Improvement: AgQhi�-'L %1 ' Address: 1 L C Tel No.: // Gy D1,35lZFiled- 'S ��4,4 ryv The Building Department will be responsible for assisting the applicant 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: Detennh= Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lots) 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: Ddermines Compliance to State and Town Requirements for Personal .................................................•---.......................................................................................--.-----• Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. RZ}VIEWED BY: 1. WATER DEPARTMENT: DATE: N/A 2. ENGINEERING DEPARTMENT. DATE: N/A HEALTH DEPARTMENT. DATE: N/A S. WIRING INSPECTOR I"USTRIAL AND/OR COMMERCIAL PERMITS DATE: N/A T 6. PLUMBING INSPECTOR DATE: N/A 7. FIRE DEPARTMENT.- DATE: N/A COMMENTS: PLEASENOTE RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Whft Cvr-BuMmaDwL - Pwkewy-We=DwL - YdImCc" -HaalmlkpL - PDACopy-Fn DcpL -Fire��~ TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Building Site Location: ProposedImprovement: The Building Department will be responsible for applicable departments. No: / 33 Lot No: � 3 dispatching your plans and or application to the following �_awj Mal FARM Rt 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: y 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: /CONSER' V¢ HEALTH J. WIRING LN.5 L't VA: unl Z. 6. PLUMBING INSPECTOR DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Whft w" - Barg DcpL - Pwk cM - wdwDcpL - Yd1ow Copy - HaM Dept - hA Copy - Ng D� - Goldenrod - Fie DcOACoavavatiao N� 5�J,,7« S� o(tdzt�,Ia- C-- 3/d /-)'a- Af 11 LOT 28 �� 0 AUG 23 PM " 24. AS/LOT A25 ,, �y 0' �o�r o� 4.0' i 6� 9 *�" v, CB AL JL AL AL RES. ZONE- "R40" This XIORTGAGE INSPECTION plan v For FLOOD ZONE• "C" Bnk e Oniv TOWN: _ REGISTRY OWNER: 0808GZJ_- �IHG ------------------ ----------- - DEED REF: _1424 .4?.K_____------BUYER:-MA81MKJ2L iLS.O1Y-------------------------• DAggT��E:-Z,1g241-1I9QA--------------- PLAN REF: _1��LL�Ls9�_ ____SCALE:I 40--- I FT. S4%NCS CBANff TO RDSTON FEDERAL THAT THE BUILDING YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS A. CONSULTANTS SHOWN AND THAT ITS POSITION DOES CONFORM B MEA. M 40B (SUITE I) TO THE ZONING LAW SETBACK REQUIREMENTS OF THE Na 3208e a INDUSTRY ROAD TOWN OF YARMOUThi AND THAT °fef aEo IT DOES OT LIE WITHIN THE SPECIAL FLOOD HAZARD MARSTONS MILLS MA. 02648 AREA AS SHOWN ON THE H.U.D. -MAP DATED_Z4WS-__ �O",I Lallos TEL 428-0055 o 't — Panel A 250015 0001 D FAX 420-5553 THIS PLAN NOT MADE FROM AN INSTRUMENT Ant—A--crvmvmvw—are e1101,s.v .,,,T IM.% in, rrcvn Fna Fcurm rrr 24483 BCB , r -- ,�_- ,_ _,__, ---,--_� I �. 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I I - � _" , ;` , '­ 1 �, ,-I % , -A i �•, ,I - j.�I 4 , I - -� I- l.4I - ,.l' , I ( , , I'I.1 _ f v V - ,—,, I � �i I4 .✓ .i: , . .t, % V­'.1--!" f , , .N� _� -1 - . - , �r - r l- N 1 ,1 .�' .I.� � .- 1 , II .- I " .., 1-,' I ,­; ".--,I, , f II r, , - . . tN1 - _ ..� , . -- ... I. -I , .II ­ /- .- I / - i ­RIT-A -_f- 0' - _ Light' post --" e I , ' -. ,51- . 1 - - - -I I ,,__- P- � . . - - Existing "drveway. I I"W " i I ­ " �. I"' , I _I.I1,-I,,v ;, 1 English boxwood -lA;, ., .,4.P '; J ,/��- � . , 4 �r - .4. ,� fI I - .'II­ -.1,C .I1, I .r ji �, � � — �.� Remove erenn.ol"bed1 :China Girl Hal I 1 - p A ,I_ , ond're—seed-town. I . , I '1.­.� I ,�k 1- — '," I .1-" .� .! "1. ��I WI it .e�,'.�m-?-; ,�1 41I "� _k A._11 ', J., .i _ r- R ve-mason !lily lq!, . !?T�!—� fi',�I_. " porch .and" replace tf1lt1 11 I1ij,,1 '4eZEdge,of mown gross k -tl-with- a oganI IJ� 1ItI ,IjIII i!0�)- I_�!A-N- �,-". -steps IM Ii I iIv1;;jj M .L ­i ." ,. � . - � __.'4 ,,, . ,_P w W _, ! II - ., .-1� i ,.�610 UoSP-eiPF - I 1 ,� . 1Existing ,QuinceIIf1,, I English boxwood -*�z. ;7 z - 0,� ,I - - I 1 Y7,N , - 4I0W I — - 2 Double Blue Hydrangea' . I, . I_ -I , I% 1es,Z- +I/ *` ieIdstone retainingwall _ I � I ', I r, . I Perennial ,nower--Bed Existi I I, 1�t . II i I , __ I t :i II .II A It III I . 1". . Mist ,," ffz`lOIVI is q r It t . 11 I I I 4t' I es"`to grade -�,r .'4 t A , Ii14H1lI1iIIt t.I i .I,lt4 I14l . I. II I I I Proposed-mahogany"deckI:t I � , . f ..I i I , Summerswe --I I1,M i I I I � I L:I""A­s -, I.1.Ii 11I 41 11Illit ` r I l $-�.� 1 ,.,, , 1" - I , I11�11I1Ii1111-I11PikII., -.--+D,4- 11E. %1Jf "If itflI f t 'W (, ,_1 __, ," (.f-I fIt; l;fH1I11'0, 4I ":J<, �I `- ..ifIt, . iIti tf z , I i '. ;- A -. _, -j � "v � �Sistnq% :Bayberry I, ��TR "ing v �-I >- : _rI' k I-- t 1 - A - * - I 2 Exis g-Rh6dodendrons l / , I I''�, � II I 1 . . rII I - .» . "_51 L,_ _.. 1 .; I.. -I .- —. 1j _. ,E I: - . --- ".I; ­''' - . a OI m a m BUILDING PERMIT FIELD COPY /yo .60 7 13•0-)-57ci 3/��UI DATE march a, 9001 PERMIT NO. 13-01-579 - APPLICANT David Dadmyn ADDRESS 51 Pond Rr of W. D nni c 074205 (NO.) (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO addition (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT ILOCATION)_41 Ellis Circle Y.P. 02575 DISTRICT 11 40 (NO.) (STREET) BETWEEN AND (CROSS STREETI )CROSS STREET) LOT SUBDIVISION 133132 LOT W50 BLOCK —nap 119 SIZE 'O. BUILDING IS TO SE ,,� FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION O Z, TO TYPE 5 R USE GROUP JR 4 BASEMENT WALLS OR FOUNDATION i O (TYPE) REMARKS: ndditlf nn• a 141 " 141 pnvrh - AREA OR MIT (CUBIC/SQUARE FEET) VOLUME ESTIMATED COST $ FEE $ 150 00 F OWNER Marion Gleason BUILDING DEPT. ADDRESS-3E35 Afa$s Ave. Arlington MA 02Ii74 BY.r�C INSPECTION RECORD DATE NOTE PROGRESS- CORRECTIONS AND REMARKS INSPECTOR -O r7-) AV, YARONE & TWO FAMILY ONLY - BUILDING PERMIT',' APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE k9TWO FAMILY DWELLING O y Town of Yarmouth Building Department F '.,.,,C,,. , 1146 Route 28 - Yarmouth, NIA 02664-4492 Tel: (508) 398-2231 a261 - Fax: (508). 398-2365 Office Use Only 7 Planning Board Information Assessors Department Information: Permit No. R�ratez,r 4) Plan Type Map Lot / a Lot Endorsement Date I Permit Fee $ /5�1 Old New a Recording Date D� Q� 1.4 Property Dimensions: Deposit Rec d. �/v, Datf Plan No. Net Due $��pr / Other Frontage (ft) Lot Coverage This Section for Office Use Only Building Permit Number: Date Issued: Certificate of Occupanc Signature: Building Official Date is is not required Section 1 - Site Information Use Group: R-4 Type: 5-B. 1.1 Property Address: 1.2 Zoning Information: zi l J6 111 S C't �- c, I -C-: IRM-S /9- Vo � A 1^ m O o } N _ _ !-^-t- W /-1 Zoning District Proposed Use, 1.3 Building Setbacks (it) • Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L c. 40. S 54) 1.5 Flood Zone Information: Com t Publi Private Zone: BFE: ll'iAR n o _ llflllJ Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: MA A i d 0 ' sf GL,9'A- I!n SO _37 �5LA; u y Na (print) Mailing Address K° 791-16yi-bEaIV Signature Telephone ,.z�uthorize t: t�r� VW U.v Nam rint) Mailing Addr Signature Telephone Section 3 - Construction Services Icensed C3kn&tructlon Supervisor: Not Applicabe Avi�A�ivty� 2 7 ?nni Oil 11 a9�r'J � O S J %60 J y0 Expiration D e Signature Telephone C;t 3 I O A 3.2 Registered Home Improvement Contractor. ompany Name Not Applicable ❑ License un f I ry Addr b Expiration D e Signature Telephone ,S D 9- 15-99 1 oft OVER 0 Y 0 Section 4 - Workers' Compensation Insurance Affidavit (M.G.L c. 152 S 25C (6) Workers CompensatiA Insurance affidavit must be completed and submitted with this application. Failure' to provide this affidavit will result in the dental f the Issuance of the building permit. Signed Affidavit Attached Yes . `. ... No .......... Section 5 - Description of Proposed Work (check all applicable) New Construction ❑ I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ I —Repair(s) ❑ I Alterations ❑ I Addition Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: , Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant Check Below Z Conservation -Commission Filing (if applicable) Old Kings Highway & Historical Commission approval (if applicable) 1. Building OO- 2. Electrical 00 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & additions) 9G Section 7a - Owner Authorization - Owner's Agent or Contractor Applies To be Completed When for Building Permit as owner of the subject property hereby authorize Jn Av d 5044M n-0 to act on my behalf, in all matters relative to work authorized by this building permit application. �t M� yC- AAOL ' ,, /5, A00•/ ) , _ , ,.. Signature of Owner Date, - Section 7b - Owner/Authorized Agent Declaration �--�AA f`^ u , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate; to the best of my knowledge and belief. t i Signed under the pains and penalties of perjury. A0: 'C�AIw,UAJ :,name �. Sign of Owner/Agent Date 9-15-99 2of 2 2°`YAk TOWN OF YARMOUTH 3Fc BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Applicant��"' • ZOP "` "� Building Permit No.: Address: S �o �r S� W Tel. No.: 760 -.S^/&Date Filed: Bldg. Site Location: Car, Map No.: Lot No.: The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COAMUSSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type • ' - of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc. HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements for Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ---------------------------------------- The following Departments must sign off, in the respective order, prior to building inspector issuing the required building permit: RE�}EWED BY: (� (� �l. WATER DEPARTMENT: \ , ` DATE: N/A 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: v4. HEALTH DEPARTMENT e DATE: % N/A. - INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: 6. PLUMBING INSPECTOR: _ 7. FIRE DEPARnIENT: - - PLEASE NOTE AU stumps and/or brush must be disposed of at an approved site. COAIAIENTS: 11frer—1, ��/� •�-rr�r� E•��LD2 DATE: N/A: DATE: N/A: DATE: N/A: 8/99 Applicant Sign Date or°fYgk�y TOWN OF YARMOUTH O BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: job Location: I/IiS C►►^cl-� n�-w�oud-Nc�r'� Number Street Village Owner of Property: ��A h t o AS 61 �'A S o Construction Supervisor:�=�Ac' •I"UAJ 6-7 Name License No. Phone No. Address: S 1 �D u S-r 4J a S'r ..,.4 a..S )'Y) O D6 76 Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current li insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes 4d No ❑ If you have checked yam, please indicat a 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 er ass. General Laws, and that my signature on this permit application waives this requirement. Check one: of Owner or Owner's Agent Owner ❑ Agent Signature: Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: D,J Est. Cost % 4o6l Address of Work Z 1 // ; S G % lr e- I z N� Owner Name: �� n N o tiJ %, �• -� /a S o Date of Permit Application: / 130 l0 1 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: r_7_ OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I here y apply for a�permit as the agent of the owner: 3v O/ '��JA�►v��,Jy�u. ��crS Date Contractor Name /D8'717 Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name The Commonwealth ojMassaehusetts Department of Industrial accidents OMOee911"estlffstlsss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit l�:S Gi hL tits \/A i^ hry a e.4 k Qp ter _nhone # `%j0 — §? z 6 C I arts C lam AT11 a homeowner performing all work myself. a sole proprietor and ha%e no one %eorkine in any capacity an employer prop iding workers' compensation for my employees working on this job. s insurance co 6) A,J i''e S-tA�,� NV'. policya L!.t�t� F166— /7 C I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who have the following %corkers' compensation polices: company name• address, cjjy• phone N: inruronrr rn _ policy. N Failure to secure coverage as required under Section 2SA of MGL 152 can lead to the imposition of criminal penalties of a riae up to 314M.00 and/or one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and arise of S100.00 a day against me. 1 understand that a copy or this statement maybe forwarded to the Ogee of Investigations of the DIA for coverage veririadoa. ! do bY -u� SlOnahlfr t��' id penalties of perjury that the Information provided above is true and co t!ect)01 Q Date /3� Print name �A,>. AO L %j,.-j Phone 746 1�j9/6 ofcial use only do not write In this area to be completed by city or town official city or town: YARMOUTIJ _ permloieense 0 nBuilding Department pUcensing Board f] check if immediate response is required 261 ❑Stltctmen's Office (508) ion "if t ❑litalth Department phone Al'. _ _ ex Mother contact person: sir.�srd 3.91 PJA1 Information and Instructions Massachusetts General t_a%%s chapter 152 section 25 requires all employers to provide workers' compensation for their entplo%ees. As quoted from the "law", an employee is defined as every person in the service of another under an% contract of hire, express or implied, oral or written. An etttplotler is defined as an individual. partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise. and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However the o%%ner of a 6%,elling house having not more than three apartments and who resides the or the occupant of the daellina house of another who employs persons to do maintenance , construction or repair work on such dwelling house or .in the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. \IG1_ chapter 15'_ 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 "ho has not produced acceptable evidence of compliance with the insurance coverage required. Additionall%. neither the commonaealtlt nor any of its political subdivisions shall eriter 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 affidavit. The affidaa 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 affdavits may be returned to the Department by mail or FAX unless other arrangements have been made.. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents office of Imstlladens 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 BUILDING TOWN OF Y A R M O U T H ELECTRICAL GAS 1146ROUTE28 SOUTHYARMOUTH bIASSACHUSETTS02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398.2365 PLUMBING SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at � ��� i S 6,3 rC- I z Work Address % is to be disposed of at the following location: .1 r ma u tN Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. 0 /0 0! Date PLOT PLAN AbuttorIs Name Lot # If this is a corner lot, write in name of street. FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) Well 0 SIDE YARD �] — — — -- FT_ [� I (lot................ft. rear) I REAR YARD I. GIB .............ft* C`Q I HOUSE Q SET BACK SIDE YARD a---. FT� (lot..................ft. frontage) (NAME OF STREET) Information Supplied by b Abuttor I s Name Lot # If this is corner la write in name of other street. MARK NORTH POINT �1 \tip 33�� m CPA 0 yy � 901 Sc02 Q� �S 0� TO THE BEST OF MY INFORMATION,. KNOWLEDGE, AND BELIEF. THE ST/zacru z�r SHOWN._ON THIS PLAN HAS BEEN LOCATED ONvj, GROUND AS INDICATED [l:RUEY DATE PROFESSIONAL LAND'0 . _..N 4y�000 sF� 62 "AS -BUILT" PLOT PLAN YARMOUTH,. MASS. DATE Z-fed 2S zoo/ SCALE /'=30' JOB ICV6_100 CLIENT cFAso..i SWEET= ENGINEERING ' 235 GREAT WESTERN ROAD P.O. BOX 713 SOUTH DENNIS, MASS. 598-3922 02660 (FAX) 398-31 4pew Old King's Highway Regional Historic District Committee in the Torn of Yarmouth for a CERTIFICATE OF APPROPRIATENESS Application is hereby made in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: E3 New Building b Addition E3 Alteration hulicate type of building: p House 0 Garage E3 Canm=ial O Other 2. Exterior Painting: p - _ 3. Signs or Billboards: p New Sign 4. Stnu tum p Fence: 0 wall TYPE OR PRINT LEGIBLY p Existing Sign p Flagpole O 0 Repainting existing sign -- `. v JUL 27 An 9:41 SOUTii Ytiii zUTH, i.SA DATE 7/6/00 ADDRESS OF PROPOSED WORK 41 Ellis Circ ASSESSORS MAP NO. 133 OWNER Marion Gleason ASSESSORS LOT NO.23 HOME -ADDRESS 385 Mass Av Arlington Ma 02474 TELEPHONE NO. 7A1-641-n634 AGENT OR CONTRACTOR Claude Co riveau TELEPHONE N0362-2639 ADDRESS P•O.Box 284 Yarmouth Port Ma 02675 USE ATTACHED SHEET IN PACKET FOR ABUTTING OWNERS DETAILED DESCRIPTION OF PROPOSED WORK. Give all paniculats.9l yyod to be done including materials to be -used. Incase of signs. give locations of existing signs and proposal lotions of neW signs. (Attach additiowl-shcet, if nax ssary). i APPROVED E YARMOUTH Commn E 1 `� OKHRD i.�, Signed/-�- r Owner -Contractor -Agent Snnce below line for Committee use only Received by OKI1C LA Date G ThisCcificatcjshc /�" _ Date r Checkq//J By yj APPROVED E3 IMPORTANT: If Catilicate is approved. approval is subject to the 10 day appeal period provided in the Act. DISAPPROVED p Please retum to: Yarmouth OKIIC District Committee Yarmouth Town Hall, 1146 Route 28, S. Yarmouth, MA 02664 rac�n►settsOeparhunt of Entrironmentet Protet;tton Town of Yarmouth Wetland 13Y-Law Bureau of Resource Protection — Wetlands Chapter 143 WPA Form 2 - Determination of Applicability Massachusetts Wetlands Protection Act M.G.L c. 13Is §40 U Determination (cont.) Negative Determination NOW No further action under the Wetlands Protection Act Is required by the applicanL However, if the Department of Environmental Protection Is requested to issue a Supersed- Ing Determnation of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post- marked for certified mail or hand delivered to the Depart- ment Work may then proceed at the owner's risk only upon notice to the Department and to the conservation commission. Requirements for requests for Superseding Determinations are listed at the end of this document. 1. The area described In the Request is not an area subject to Protection under the Act or the Buffer Zone. C 2 The work described In the Request is within an area subject to protection under the Act, but will not remove, fin, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the AcL Therefore, said work does not require the filing of a Notice of Intent. 4. The work described In the Request Is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. Authorization This Determination Is Issued to the applicant and delivered as follows: C by hand delivery on ream xaa by certified mail, return receipt requested on _June 19. 9nnn vw This Determination is valid for three years from the date of Issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Deterrninat►on does not relieve the applicant from comPOng with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. 5. The area described in the Request is subject to protection under the Act Since the work described therein meets the requirements for the following exemption, as specified in the Act and regulations, no Notice of Intent Is required: ' famOtAtaw'y C 6. The area and/or work described in the Request is not subject to review and approval by ehrxc1AWaQp wy Pursuant to a municipal wetlands law, ordinance, or bylaw, (name and ckation of bylaw). This Determination must be signed by a majority of the conservation comnission. A copy must be sent to the appropriate Department of Environmental Protection regional office (see appendix A) and the property owner (if different from the applicant). TOWN OF YARMOUTH BOARD OF APPEALS DECISION FILED WITH TOWN CLERK: October 11, 2000 PETITION NO: #3640 HEARING DATE: September 28, 2000 PETITIONER: Marion Gleason Y/-' F9K110UTH T0V%!, -! 17•LE"RK 79D OCT I 1 PH 1: 4 3 RECEIVED PROPERTY: 41 Ellis Circle, Yarmouthport Map: 1339 Parcel: 23 (119/A25) Zoning District: R40 MEMBERS PRESENT AND VOTING: David Reid, Chairman, James Robertson, Joseph Sarnosky, Diane Moudouris, John Richards, Robert Reid, Alternate. 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 proposes to demolish an existing deck and replace it with a one story three (3) season porch. As the structure would extend to within 17' of the property's rear lot line, where 20' is required in the R40 zone, a Special Permit was requested. The petitioner represented that the proposed design and location has received the approval of the Old Kings Highway Committee and the Conservation Commission. The existing deck is apparently built without the benefit of any building permit. The proposed enclosed porch would not be heated but would be enclosed to the weather. Neighbors objected to the proposed expansion of the small home. Board members observed that the petitioner had several other solutions apparently available to them, including relocating the porch or simply reducing its size to meet the 20' setback which would apparently not require any relief. The petitioner requested leave to withdraw the request for the Special Permit. Mr. Robertson made a motion to allow the petition to be withdrawn with out prejudice. Mr. Richards seconded the motion which passed unanimously in favor. �yyy� �J David S. Reid, Clerk APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (hIEC), 527 CMR 12.00 TOWN OF YARMOUTH (OFFICE USE ONLY) By Fee: $ PERMIT NO. E OI O �(p (PLEASE PRINT IN INK OR TY�' L INFORMATION) Date: To the Inspector of Wires: By tliis appli , lion the undersigned gives notice of his or her intention to perform the electrical work described below. o 30 ti"),`L Location (Street & Number) YJ AFL L'I Owner or Tenant M -zv-t oN ('r I e a G e) l.I Telephone No. Owner's Address `S`dS' M-tsS. Avg. Qvdtv,c-4-rLV,NA. oagm/ Is this permit in conjunction with a building permit? �d'Yes []No (Cheek Appropriate Box) Purpose of Building Sin rds ��Ir�l�., wc��in��. Utility Authorization No. Undgrd ❑ Existing Service /CO Amps 3 U // ) o Volts New Service Amps / Volts Number of Fceders and Ampac Location and Nature of Proposed electrical Worj:: Overhead0r Overhead❑ 0 No. of Meters / Undgrd ❑ No. of Meters Completion of the following table may be traived by the Inspector of Rires No. of Recessed ix ur s -Sus ad No. of Tots Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool rnd. ❑ frnd. ❑ No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. ot Deteclion an Initiating Devices No. of Ranges "fora No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers t eat ump Totals: um er — one — — h — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local ❑Other ❑ Connection No. of Dr ers y Heating Appliances KW g pp Security Systems: No. of Dcvtces or E ui valcnt No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of i5evices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or uivalent Attacli addthonat detad if desired, or as required Uj the Inspector of wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies t at such coverage is in force, and has exhibited proof of same to permit issuing office. JJ CHECK ONE: INSURANCE 2r BOND[] OTHER❑ (Specify:) ? n& (Expiration Date) Estimated Value of Electrical Work: /0001 00 (When required by municipal policy.) Work to Start: Y h I Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under th pains and enal ics of perjury, that the information on this application .is true and complete. FIRM NAME: 1 LIC. NO. tF/SV 7 g U Licensee: Pt . Q 15 i I r_ Signature LIC. NO. 5 1 r 7 j C (If applicable, enter "exempt" in the license number ling.) Bus. Tel. No.: /-,1 1-7-'33 /- 73 9/ Address: AIS-H:31V SA 8918/ Ai2AtCk LNI�c;L4)2 Alt. Tel. No.:/-6/q-3_S%9 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner 2-01 owner's agent. /- 7 �/ G ��/ _ 6 3 IL/Owner/Agent � Signature `�� "� �7 '� Telephone No. /- SVA ' 4c� - 557 l Rev. tunxtl uuc, THE COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF APPEALS - Appeal #3677 Date: April 11, 2001 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 lj� Special Permit has been granted To: Simon's Supply Company. Lnc• Address: 586 Higgins Crowell Road City or Town: West Yarmouth. MA 02673 J affecting the rights of the owner with respect to land or buildings at: 586 Higgins Crowell Road, 1p. West Yarmouth, MA. Assessor's Map: 84, Parcel: 3, (64/E8) Zoning District:113 and the said Board of Appeals further certifies that the decision attached hereto is a true and correct vcopy 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 with the Planning Board and the Town Clerk. 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 Pemrit, or any extension, modification or renewal thereof, shall take effect until a copy of the decision bearing. the J certification of the Town Clerk that twenty (20) days have elapsed after the decision has been filed 1 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 land which the 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. ` David S. Reid, Clerk CERTIFICATE-S.P#3 677. WPD TOWN OF YARMOUTH BOARD OF APPEALS DECISION FILED WITH TOWN CLERK: October 11, 2000 PETITION NO: #3640 HEARING DATE: September 28, 2000 PETITIONER: Marion Gleason Y/'.9F M01JTHI! TO\t:�i . i1,._-RK 7® OCT I I PIS 1: 43 RECEIVED PROPERTY: 41 Ellis Circle, Yarmouthport Map: 133, Parcel: 23 (119/A25) Zoning District: R40 MEMBERS PRESENT AND VOTING: David Reid, Chairman, James Robertson, Joseph Sarnosky, Diane Moudouris, John Richards, Robert Reid, Alternate. 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 proposes to demolish an existing deck and replace it with a one story three (3) season porch. As the structure would extend to within 17' of the property's rear lot line, where 20' is required in the R40 zone, a Special Permit was requested. The petitioner represented that the proposed design and location has received the approval of the Old Kings Highway Committee and the Conservation Commission. The existing deck is apparently built without the benefit of any building permit. The proposed enclosed porch would not be heated but would be enclosed to the weather. Neighbors objected to the proposed expansion of the small home. Board members observed that the petitioner had several other solutions apparently available to them, including relocating the porch or simply reducing its size to meet the 20' setback which would apparently not require any relief. The petitioner requested leave to withdraw the request for the Special Permit. Mr. Robertson made a motion to allow the petition to be withdrawn with out prejudice. Mr. Richards seconded the motion which passed unanimously in favor. David S. Reid, Clerk TOWN OF YARMOUTH BOARD OF APPEALS APPLICATION FOR HEARING Appeal #: No 40 Hearing Date: ft Fee$. � Applicant: f)TARio/V G-�a6yofj r ��i (Full Name- including d/b/a) 100 AUG 23 PM 1:2 (Address) J (Zip) (TelephoneNumber) —6gl and is the (check one) t-Owner ❑ Tenant ❑ Prospective Buyer ❑ Other Interested Party 01C.,3` Property: This application relates to the property located at:4�/ E!fis 6P L /C vfy-,- which is alsoshown on the new Assessor's Map: / .3 3 _ as Parcel: _ Z__:_(old Map &Lot #) ll� r}.�� Zoning District:_ _ y� Project: The applicant seeks permission to undertake the following construction/use/activity :(give a brief description of the project. i.e.: "add a 10' by 15' deck to the front of our house" or "change the use of the existing building on the property"): 'moo C_ i"g 4 -¢h r. /L_sv, er G 4 e,g.x f rl in;r i_✓t.r k CII i-Itf crs C. _ .- -!.... L. - l .-i .4 d RELIEF REQUESTED: The applicant seeks the following relief from the Board of Appeals: I ) REVERSE THE DECISION OF THE BUILDING INSPECTOR OR THE ZONING ADMINISTRATOR dated (attach a copy of the decision appealed from). State the reason for reversal and the ruling which you request the Board to make. 2) SPECIAL PERMIT under §' U J 3, ±£ of the Yarmouth Zoning By-law and/or for a use authorized upon Special Permit in the "Use Regulation Schedule" §202.5 3) VARIANCE from the Yarmouth Zoning By-law. Specify all sections of the by-law from which relief is requested, and, as to each section, specify the relief sought: Section: Relief sought: Section: Relief sought: Section: Relief sought: Additional comments: a,/�VAF Z n ,J FACT SHEET This sheet must be completed and filed at the time of application. Owner of Property (if other than Name) ( Address) How long has the owner had title to the above premises: 1 - (Telephone Number) (Give title reference if available) Use Classification: Existing:. §202.5 # rl I Proposed: n£ V §202.5 # Is the property vacant: aV d How long has it been vacant: Lot Information (if available) Area: 1. aLl ck,, Subdivision/Plan Reference: / /r Is this property within the Aquifer Protection Overlay District: Yes No' ✓ Other Department(s) Reviewing Project: Indicate the other Town Departments which are/ have/ or will review this project, and indicate the status of their review process: Repetitive Petition: Is this a re -application: If yes, do you have Planning Board Approval: Prior Relief.• Ifthe property in question has been the subject of prior application to the Board of Appeals or Zoning Administrator, indicate the Appeal number(s) and other available information: A)oh E ADDITIONAL INFORMATION: Please use the space below to provide any additional information which you feel should be included in your application: Applicant's Signature/Attorney Address Owner's Signature n.1L A AL. oe Irding Inspector's Signature Site Plan Review Required Completed ❑ Yes 0 No 0 Yes 0 No .. - LOT 28 �� _ ✓e�000� Y��� 00 AUG 23 Pn-.1.2 29� 04. 3' . _.. AS%LOT A2 1 y- 4.0' ig6h i ys �o0 04.3'=" ,0 oo J am A1 Of v, CB AL AL AL AL Alu. w� Eo AL j RES. ZONE- "R40" This MORTGAGE INSPECTION P'an 's Bank Us TOWN: _ RT___________ REGISTRY OWNER _CEQB9ZJ_.. DEED REF: _1484 _42A___________BUYER: �BB1Q� rr�A�so�y-- DATE: 2,2-41,9A --------------- PLAN REF: _Z�s_l51 dc_D I HEREBY Cif TO .5Q.STON 1r of SA V`NGS ANK THAT THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS ��� PAUL SHOWN AND THAT ITS POSITION DOES CONFORM 3 A MEA'THEW TO THE ZONING LAW SETBACK REQUIREMENTS OF THE Y, TOWN OF EAMITH AND THAT IT DOES JVUy' LIE WITHIN THE SPECIAL FLOOD HAZARD °FcisltaEo, AREA AS SHOWN ON THE H.U.D..MAP DATED_'/�s/�_ �OM,I uoos� rom unity —Panel B 250015:0001 D pnDL—a t� fi THIS PLAN NODE USED FOR FENCE FLOOD' ZONE` "C" V------------------- SCALE:I"= 40 _FT YANKEE SURVEY CONSULTANTS 40B (SUITE 1) INDUSTRY ROAD MARSTONS MILLS, UK 02648 TEL' 428-0055 FAX' 420-5553 24463 DCB 22 PISA214 k. . r lulu 25 N lllOA26T 23/ 11 1 1. AC Ar ills 32 VION501 AIAC 0.T i) 76 AC is 9IN5z 70 AC nlgN&31 &W AC., 40 (IIIES71 *78 AC 42 (11 63) AC rlwtli IIEI 0 1 I AC .".37 AC — — — — — — — — ---c — — — — — — — — — — — - - - - — — — --%- — - m MATTH 6I2=15 SlipGen- Portal Hone Document Category Map -Block Number Street Number Street Name Department Parcel ID Backfile Batch Scan Document? Additional Naming Info Index Operator Date - Time Town of Yarmouth Template [Building Dept] Slipsheet Identifier [sg29787] Building Permits 133.23 0041 ELLIS CIR Building 16235 M6, Operator, Yarmscan 2015-06-29 - 15:35 tt4pJAaserfiche12GipGerrr 1I1