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Home My WebLink AboutBuilding PermitsTOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 R 508-398-2231 ext. 1261 Fax 508-398-0836 FILE COPY Email jbrandolini@yarmouth.ma.us March 20, 2014 Ms. Martha Zum 172 Blue Rock Road South Yarmouth, MA 02664 Re: 172 Blue Rock Road, Accessory Apartment Dear Ms. Zurn: This is to serve as a follow up to my August 27, 2013 letter concerning the Accessory Apartment located at 172 Blue Rock Road and the required inspection of this unit. That letter requested your cooperation in contacting this department and scheduling this inspection within fifteen (15) days. However, as of this date we have not heard from you on this matter. Accordingly, you are hereby notified once again to contact us by phone or email noted above, to make this inspection arrangement. Failure to do so may result in appropriate enforcement action pursuant to the provisions of the Town of Yarmouth Zoning Bylaw, Section 407.4.3 Very truly, J"VLrandolmi, Deputy Building Commissioner TOWN OF YARMOUTH FILE Copy BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext.1261 Fax 508-398-0836 August 27, 2013 Ms. Martha Zum 172 Blue Rock Road South Yarmouth, MA 02664 Re: 172 Blue Rock Road Accessory Apartment Dear Ms. Zum: Please be advised that the Town of Yarmouth Zoning Bylaw, Section 407, entitled Accessory Apartments, requires all Accessory Apartments, which include Family Related and Affordable units, approved by the Board of Appeals, pursuant to theses provisions, be inspected every two (2) years, as per Section 407.4.1, According to our records your Accessory Apartment approved by the Board under Special Permit, Petition No. 4109 located at 172 Blue Rock Road, is now due for inspection. Therefore, you are hereby advised to contact the Building Department Office to make this arrangement. Please contact us within fifteen (15) days at 508-398-2231, extension 1261, by email, at Icipro@yartnouth.ma.us or by coming into the office during the hours of 8:30 AM to 2:00 PM, daily. A $25 fee is required for this inspection, as specified in Zoning Bylaw, Section 407.4.1 and set by the Board of Selectmen. Please make your check payable to the Town of Yarmouth Thank you for your anticipated cooperation and please feel free to contact us should you have any questions concerning this matter. Very truly, FItoe COPY James D. Brandolini, Deputy Building Commissioner TOWN OF YARMOUTH BUILDING DEPARTMENT ' 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext.1261 Fax 508-398-0836 August 27, 2013 Ms. Martha Zum 172 Blue Rock Road South Yarmouth, MA 02664 Re: 172 Blue Rock Road Accessory Apartment Dear Ms. Zum: Please be advised that the Town of Yarmouth Zoning Bylaw, Section 407, entitled Accessory Apartments, requires all Accessory Apartments, which include Family Related and Affordable units, approved by the Board of Appeals, pursuant to theses provisions, be inspected every two (2) years, as per Section 407.4.1, According to our records your Accessory Apartment approved by the Board under Special Permit, Petition No. 4109 located at 172 Blue Rock Road, is now due for inspection. Therefore, you are hereby advised to contact the Building Department Office to make this arrangement. Please contact us within fifteen (15) days at 508-398-2231, extension 1261, by email, at lcipro@yarmouth.mmus or by coming into the office during the hours of 8:30 AM to 2:00 PM, daily. A $25 fee is required for this inspection, as specified in Zoning Bylaw, Section 407.4.1 and set by the Board of Selectmen. Please make your check payable to the Town of Yarmouth Thank you for your anticipated cooperation and please feel free to contact us should you have any questions concerning this matter. Ve 3834 53-71642113 4 2�i ►3 01 Jar. ate De I $ 25.oe co Coo Dollars 8 3834 •• • ^ - r tai� a MASSACHUSETTS UNIFORM APPLICATION- FOR PERMIT TO DO PLUMBING .fPrnto Type 0 Mass. Date 6-� 30'07 Permit# -D,7— �%Z Bull ! Ingo Location %� L ✓e RxK 0-2 Owner's Name 2- U 2nl S c M 0 0 Type of Occupancy S Ne v age enovation ❑ Replacement Plans Submitted: Yes ❑ No �" 1� • FIXTURES n on�mo ��000 auoo� o0 ■ a000 �ruo� u� �u�auo m nmoo� PInstalling Company Name R , G y ' s Tnr. _ Address 222 Mid —Tech Drive West Varmnnth Business Telephone 508-775-1303 Name of Licensed Plumber Frank W.__Rrzderick Check one: Certificate Corporation 1762 C ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability policy or Its substantial equivalent which meets the requirements of MGL Ch, 142. Yes No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy K Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have•the Insurance coverage requlred by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and informaticn I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Zodrhapter 142 of the General Laws. By Title SignatGre of Licensed Plumber City/Town Type of License: Master ❑ Journeyman ❑ APPROVED (OFFICE USE ONLY) License Number 7:q4 _ W MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date 6 Y. 2( a Z Permit it r1 / Building Location 17.) St, Je Ao CCk �P Owner's Name Zv�YJ Owner TeU{ ' / m/bW Type of Occupancylt' New t3' Renovation ❑ Replacement ❑ Plan Submitted: Yes ❑ No a-� FIXTURES Installing Company Name P,4sri Is Tivc Check one: Certificate Address 2;12 M 4—TO 01`7�L t (Corporation 174a C Mar yArnitl, MA 02473 ❑ Partnership Business Telephone # 6-09-77S— 1303 ❑ FimUCo. Name of Licensed Plumber or Gas Fitter f-7ZANK W. POdek7i lK INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ IT you have Icked yLs , please Indicate the type coverage by checking the appropriate box. A liability insurance policy 1( 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 D hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my nowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of tho-GLfRneral Laws. By Type of License: • -Plumber Signature of Licensed Plumber or Gas Fitter Title ftter 7791j 9rMaster License Number_ 7 City/Town rneyman APPROVED (OFFICE USE ONLY) Foam 1243 _i HOBBS s WTW9"bT D r �o . V/,M �••^ - real" aA,; ►,MASSACHUSETTS UNIFORM APPLICATION- FOR PERMIT TO DO PLUMBING (Pri t or Type) Mass. Date 2 0 • Permit #?� ng Loca � D Bull iion / is Mie 0I Owner's Name Jau nth LvrrA Type of Occupancy e5, ete.K"4 Ne v age lRenovation ❑ Replacement 'Plans Submitted: Yes ❑ No ❑� FIXTURES I I b� Q of a� N �MpQ�nli1■Itli�f■■�■�S�■Olp■�� .. - ■�■■u�u■■■■■■goo■■■m■ Installing Company Name Rus y l s Tn� _ Address 222 Mid —Tech Drive West Varmnuth Business Telephone 508-775-1sos ivame or uL;enseu riumoer r•ranx w. xaaericx Check one: Certificate gist; Corporation 1762 C ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch• 142. YesX 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 coverag required by Chapter 142 of the Mass. General Laws, and that my signature on this permit appllcatic waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the detalls and information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse s 5tate Plumbing Code and Chapter 142 of the General Laws. By Title Signature of Lcensed Plumber City/Town Type of License: Master Journeyman ❑ APPROVED (OFFICE USE ONLY) License Number 7794 it , June 7, 2007 To whom it may concern: `uw !\! 2007 ©UILDING DCpT. This letter releases Oslen Plumbing and Heating from any work or permitting required for 172 Blue Rock Road, S. Yarmouth, MA. I hereby authorize Rusty's Plumbing to file for any and all permits needed for the completion of this job in order to obtain the necessary occupancy permits. If you have any questions, please contact me at the numbers provided below. Sincerely, Martha H. Zurn Cell 508-3264224 Home508-694-6060 Iki \nO L_}\�"� V�•��\ c� CD N r0 a -a ca MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Y l� 2 VYl u-u n 4 oo(�� ,Mass. Date �� z . 20 V permit # _ D-' �r Building Location / %,Z 'J�Lp I�ClL 9A Owner's Name Z-"A4t� Owner Tell/ � -Ct-Lit-'f-t1 Q0AWUPJVL Type of Occupancy�e New ❑ Renovation ❑ Replacement ❑ Plan Submitted: Yes ❑ No ❑ FIXTURES '��CI�C6 IC ��IIII �■a��iiviiui� Installing Company Name P,4sry lS TNG Check one: Certificate Address 2;12 Mid -To 19y✓c Corporation 174,Z C Y M7— YQvr+fawn MA OZG73 ❑ Partnership Business Telephone # 5'09-77S- 1303 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter FMNK RodCvlcX INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have Icked yLs, 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 ❑ hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my iowledge and that all plumbing work and Installations performed under the permit Issued for this application will be in compliance with all ?rtinent provisions of the Massachusetts State Gas Code and Chapter 142 of thg neral Laws. By Type of License: /r LCK �!/ i`t�cet icfl%n�uj • -Plumber Signature of Licensed Plumber or Gas Fitter TiUe • •G fitter 77Q� �tMaster License Number 7 City/rown •. rneyman APPROVED (OFFICE USE ONLY) oFE r,9+Y ci W��CMEES! TOWN OF YARMOUTH APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) REC Ell V ED By OCT 2006 Fee: $ �� PERMIT NO. P— 07 — (0pp % DING DEPI er: Date tic Z 20 0 Building �j %r // Owner's AT. Location' l ! Z �Jr� �oc x �d Name_ Type of Occupancy Replacement ❑ New❑ Plans Submitted Renovation Yes❑ No El -2L -�J.-,t4j 4 1 z z N Y J Q V N Q Q U) 2 = t7 y a �1C(J OJ w w N N=� ~ a cc N Y 2 a LL Q a a 3 r aYc. / U Z ¢ Q W z C Q N Z 2 a 0 S V' M' • 1 �1 Lu S Q = S Lu 3 Q 3 U) 0 Y 1�- Q Y a O W LL U. W ata a°xOv Z= ao z 0. o 0 o aXW¢aOQI- W F- O U = 3 Y c o g a 3¢ t f m yr s In LL 0= Ina m o !99BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR -6ji-V-H zd fltch OL564,3 GIB (PRINT OR TYPE) Installing Company Name Address r 7 ac Cheg4C One: i✓-6orp. _ ❑ Partnership ❑ Firm/Comoanv Business Telephone :O K 3 8 5-5-22<S Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes ❑ No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of [1 f,the Mass. General Laws, and that my signature on this permit application waives this requirement. Check on Owner ❑ A e ❑ Yt SignatureofOyvnerorOwner's Agent t / - (/7-(P�If1 )V f_t�(j�LY_L ,('R-4`�_`n � 1Al l•L�. 'PCs"` �-/ ' I hereby certify that all of the details and Information I have submitte Signature of Licensed (or entered) in above application are true and accurate to the best of Plumber my knowledge and that all plumbing work and Installations performed r— under Permit Issued for this application will be in compliance with all D 3 3 S pertinent provisions of the Massachusetts State Plumbing Code and License Nu bar Chapter 142 of the General Laws. Ty Maste Journeyman ❑ t;" �e %yw cA _N 0 .11 TOWN YARMOUTH ?AUG 1 7 2006�5 r/ APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By Fee: $ ? 0D PERMIT NO. _P-o-7 - (a 1 Date Building Owner's Jr IJ AT: Location (72 v'e-�L� Name Type of Occupancy New ❑ Renovationx Replacement ❑ Plans Submitted Yes ❑ No ❑ Z �[ v4"t� fn N (n O cn Z Z W W co .� N Q V Q O y 2 2 Y G1 N j Z N y W N Fa„ U) W 2� 2 ~ 2 a W 0 y Y z Z � o. O U. Z Q Z a Z Q a 3 F 7F X N� �� U W O W Q N o Q w Z N 0 Q rN Z¢ O a D 0 U. 0 2 3 '� S f- Q Y 2 U. M W I- r 1 > FS- O 2 S N a 0 7 aa Cn Q F o Z a O J O 0 rA a¢¢ Z Z W a¢ F a O 0 V a� Y J M 0 C t] J 2 F- N U. a O G Q 3 2 m 0 SUB•BSMT. BASEMENT 1ST FLOOR 1 3 ( � 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name Address Business Telephone rit, s,c A61-�eog(, •-s* Check One: ❑ Partnership ❑ Firm/Company Name of Licensed Plumber. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes ❑ No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature or Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent Signature of Licensed Plumber License �Num�r Type: Master K, Journeyman 0 G ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE 0 WELLING Town of Yarmouth Building Deparu nt 1146 Routc 28 - Yarmouth, h1A 02616 4492 Tcl: (508) 398-2231 x261 - Fax: (508) 39&0836 Office Use Only Permit Permit Fee $ ✓, Deposit Rec'd. $ ga Dates Net Due $ Planning Board Information n pe Endo emenl Date ding Date PI n No. er Assessors Department Information: Map Lot J New 1.4 Property Dimensions: Lot Area (sf) Frontage (ff) Lot Coverage This Section for Office Use Only Building Per t umber Date Issued: .- Signature: Certificate of Occupancy is Is not required Building Official Dat Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning Information: Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required I j rn-, -9-- p pProvi 1.4 Water Supply (M.G.L. c. 40. S 54) Public Private 1.5 Flood Zone Information: Comment Zone: BFE: O 5 2007 Section 2 - Property Ownership/Authorized Agent �G DEPT I 21 Owner of Record: By Name (print) MA?,_VVAA 1i.ZUR� t"12 Mailing Address �luc2oc%,-P-Q..t S.yaYmuV�Tl� rnA Signatur CZZ Telephone F E-mail (5D8) �694- Gouc> Z Authorized Agent: CW Sag 3a6 yZZ Name (print) Mailing Address Signature Telephone E-mail Section 3 - Construction Services. 3.1 Licensed Construction Supervisor: C+, 50,Lw'G LI Number et' Address Expiration Date Signature Telephone Fax E-mail 3.2 - Registered Home Improvement Contractor. Company Name Registration Number Address Expiration Date Signature Telephone Fax I E-mail 1 of 2 OVER Section 4 - Workers' Compensation Insurance Affidavit (M.G.L. c. 152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... Section 5 - Description of Proposed Work (check all applicable) New Construction I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: kr+c 1� e� � i t law a a,•-f vv� Ph-1 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 ` GOO 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses s additions) To be Completed When for Building Permit Section 7a - Owner Authorization - Owner's Agent or Contractor Applies I, , as owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Section 7b - Owner/Authorized Agent Declaration I, , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print name `� � Sl31lo"1 Signature f r/Agent Date 9-15-99 2 of 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 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: Est. Cost ddress of Work 1, Z 5of 20cyc 2oet d S -'Y" Y'na 0 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: 5 31 0 � �"� •}— Date .�bwner Name t� The Commonwealth of 11lassachusetts Department of Industrial Accidents Office of Investigations 600 1Vashington Street Boston, AAA 02111 r www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): t-1 Z. tie (20 c K goad City/State/Zip: S. lafvt7 gfMo &i_" Phone #: S 08 - (oG't - (noc.> o Are you an employer? Check the appropriate box: 4. I am a general contractor and I 1. ❑ I am a employer with ❑ employees (full 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 equired.] 3. [ am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hued the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.= 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. New construction 7. Remodeling emolition 9. ❑ Bu lding addition 10.❑ Electrical repairs or additions I LF] Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other Any applicant that checks box #1 must also fill out the section below showing their workers' compcauation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lie. 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 $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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby certi# under the pail s a enalties of perjury that the information provided above is true and correct T,w �—�, Date: 5� it �0-1 denature: — Of ficial use only. Do not write hi this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone M pF'Y�1i; TOWN OF YARMOUTH BUILDING DEPARTMENT -ATTAC W:-$l 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 260 d HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: 1-1 Z 61.re (2-oc tc - (Lo d S. 7 A v w,u U ti-, NAME STREET ADDRESS SECTION OF TOWN `HOMEOWNER" ZO'Rv-) S08 G9ti- L cor o 50S zo:- - Spoo NAME HOME PHONE WORK PHONE P ENT MAILING ADDRESS CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code Section 108.3.5.1) Definition of Homeowner: Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and / or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner" shall submit to the building official, on a form acceptable to the building official, that he / she shall be responsible for all such work performed under the building permit. (Section 108.3.5.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. MEOWNER"S SIGNA RE Z 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. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ h:homeownrliccump BUILDING TOWN OF Y A R M O U T H ELECTRICAL GAS 1146ROUTE28 SOUTHYARTH b10UMASSACHUSETTS0266411451 PLUMBING Telephone (508) 398-2231, Ext. 261 — Fax (508) 398.2365 SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 1'7Z bi`'e PoC-k (�"`L S. yQvrnau`k-, Work Address is to be disposed of at the following location: Na d'' z os "Q' y\y U 5 S"" Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. 513110"1 Date TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be compleled by Applicant: Building Site Location: %-12- P--:.\.rc_ (LoLIe. R6Ac1 S.ygrr►�o�hJ.VlapNo.: pi_LotNo.: c17— Proposed Improvement: In �qu.j .✓�w,ev�-�- cstl ° z�&- z.zy Applicant: -r 1A4tV i r14. Z'1YV. Tel. No:: 502 4o94-(uo(op Address: I"1'Z Q)tue- Pock Paced 5jAy no0`it-► AMA Date Filed: * *Ifyou would like e-mail notification of sign off; please provide e-mail address: Y"\ 2u RN Owner Name:'T'>vv, ,m -r fAgkv V�-. Z I-3v v\ c.Il GOT 324-42z4 Owner Address: 0 Z-- elye_ C_ ._ (Zt%a d. Owner Tel. No.:. �g - (oti�1-lo Ocoa RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit four (4) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) - Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: 1J� (/�(/ DATE:l!'-�lS —D PLEASE NOTE c Doc=1s065s344 05-31-2007 10=07 BARNSTABLE LAND COURT REGISTRY TOWN OF YARMOUTH BOARD OF APPEALS n n ll, f OU I H ZONING ADMINISTRATOR DECI ; •, rni� FILED WITH TOWN CLERK: April 30, 2007 ^" !] �;" ? J P�1 2 27 PETITION NO: #4109 HEARING DATE: April 26, 2007 PETITIONER: Tommy R. and Martha H. Zurn PROPERTY: 172 Blue Rock Road, South Yarmouth Map & Parcel: 101.159 Zoning District: R40 ZONING ADMINISTRATOR: Joseph Sarnosky 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 applicant seeks a Special Permit from bylaw §407, in order to be allowed a family related accessory \� apartment addition to the side and rear of their single family home. The property is located in the R40 zone t� and contains 29,062.5 square feet of area. The addition will meet the bylaw requirements as to setbacks and lot coverage. The apartment will contain one bedroom, bathroom, kitchen, and living room, in approximately 576 square feet of area. There is adequate parking on site to accommodate the extra vehicle. The owners have filed with the Board an affidavit certifying that they are"the owners in residence and that the apartment will be occupied by Mrs. Zurn's father. No one spoke or wrote in opposition to the request. The Zoning Administrator found that the request for the family related accessory apartment meets all of the bylaw requirements, and that the owners are aware that the Special Permit lapses upon sale of the property or if the family member no longer occupies the apartment. The Special Permit is therefore granted. No permit shall issue until 30 days from the filing of this decision with the Town Clerk. Appeals from this decision shall be made pursuant to M.G.L. c. 40A §13 and must be filed within 30 days after the filing of this notice/decision with the Town Clerk. David S. Reid, Clerk FAMILY RELATED APARTMENT AFFIDAVIT AFFIDAVIT OF: (Name of Petitioner) UWE: hereby certify that Uwe are the owners in residence, and will OCCUPY the main pardon of the residence, at 1-17- PNvc POCK M0L h-k MA b2co(.H (Address) UWE further ccttify that the FAMILY RELATED APARTMENT at said address will be occupiedby. �A- }�Yriso (Name) Who is 44 th e r i v, 1 a LJ �Q_hio V (Relationship to petitioners) Signed wxkr(thhe pains and penalties of perjury, this day 7 day of r, 200 r Z. COMMONWEALTH OF MASSACHUSETTS Barnstable, as. On this tho &L'1-4 day of ?90- before me. month Year Name of Notary Public The undersigned Notary Public personally Name of Signer(s) - PmvodtQ me through satisfactory evidence of identity, which was/wcre R � � ►A U p� I� Z Con �� 0 to be the persons) whose name(s) was/were signed on the preceding or attached document in my who swore or affirmed to me that the contents of this document is truthful and accurate to the best belief_ C RHONDA L LAFRANCE } Notary PuDNc =tm ty Cann W ai E�YN t;av a 20 t t Place Notary Seal and/or Any Stamp Above My Commission Expires H \MyFilcs\Doom=U\Appli=icmVffWavitFamilyRdatcd.doc 0- of Notary Appeal #4109 COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF APPEALS Date: May 31, 2007 Certificate of Granting of a Special Permit (General Laws Chapter 40A, section 11) The Board of Appeals Zoning Administrator of the Town of Yarmouth Massachusetts hereby certifies that a Special Permit has been granted to: Tommy R. & Martha H. Zurn 172 Blue Rock Road South Yarmouth, MA 02664 Affecting the rights of the owner with respect to land or buildings at: 172 Blue Rock Road, South Yarmouth. Map and Parcel: 101.159, Zoning District: R40, 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. - 0=�-' David S. Reid, Chairman TOWN OF YARMOUTH TOWN CLERK CERTIFICATION OF TOWN CLERK I, Jane E. Hibbert, Town Clerk, Town of Yarmouth, do hereby certify that 30 days have elapsed since the filing with me of the above Board of Appeals Zoning Administrator's decision 94109 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 BENCH MARK --TOP do CENTER OF WD. STAKE— 36.32 ASSIGNED (28' OFF HOUSE CORNER) N /F 22.0 MACNIECE L3 . � c BENCH MARK--MAG. NAIL SET IN PAVEMENT- 43.61 ASSIGNED 3e., ,.7 , ,c..- i (21'-6' OFF HOUSE CORNER) • 42.2 7L. 00 PA VED �.0 C {42 — e.So ARK�IyG v�^i];.., r: _.A \ ?y a '6 4261 92 Ale 41-611 /269200±S.F. ,oi All a. 14,. \/ MA ll,E.42.9 3 4,1 \ ----- ' \ ; P4 A.op E \ O \\\ \�H 13pJ �� 9.0� N/ F DOUGLASS `\\ DESIGN & CONS lop z 1. DOWNSTAIRS BATH AND BAR O PLUMBING WITH AN EJECTOR 2. UPSTAIRS PLUMBING TO BE F O artmcnt 3. REDUCE GRADES OVER LEACF Yarmo th Health Dep A PROVED EXTRA PEASTONE TO MAINTAI ` Date Tulc- nl AAI w r TOWN OF YARMOUTH Building Department BUILDING _ . _ _ _ _ _ _ _ . (508) 398-2231 ext.261 PERMIT NO i?B-07-1397 PROPOSED USE ' PERMIT •. ISSUE DATE_6/5/2007_ _ ; _ _ _ _ _ . _ _ APPLICANT'Manhaiur;-•-----""" JOB WEATHER CARD PERMIT TO Alterations AT (LOCATION) 10172BLUE ROCK RD ZO DIS�9C R-40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 101.159 LOT SIZE BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 finish kitchen area to create an in-law apartment as per BOA petition# 4109 and per plans dated REMARKS 06/04/07. AREA (SO FT) EST COST ($ $4,600.00 OWNER IMartha,Zum KyU ADDRESS 101172BLUEROCKRD Yarmouth Certificate Issue Date *-,r PERMIT FEE ($) DEPT BY CONTRACTOR LICENSE PHONE 15083264224 F; ,CERTIFICATE -of OCCUPANCY �» Departmbntal Approval for Certificate of Occupancy and Compliance Inspector Date Permit Number Approved By Remarks Uf7`A A EM 1=3 F9014Z- IE�Qr1 1151!111►�/ ENGINEERING ,l • • To be filled in by each division Indicated hereon upon completion of its final Inspection. a r144 TOWN OF YARMOUTH Building Department BUILDING j) (508) 398-2231 ext.261 PERMIT PERMIT NO FB-07-1397 y ISSUE DATE :- _6/5/2007- . ; PROPOSED USE _ _ _ . - APPLICANT ,Martha Zum JOB WEATHER CARD PERMIT TO Alterations AT (LOCATION) 10172BLUE ROCK RD ZONING DISTRIC R-40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1101.159 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R- LOT SIZE CONT finish kitchen area to create an in-law apartment as per BOA petition# 4109 and per plans dated REMARKS 06104/07. AREA (SO FT) EST COST ($ 1$4,6PERMIT FEE ($) $75.00 OWNER Martha Zum BUILDING DEPT BY ADDRESS 10172 BLUE ROCK RD South Yarmouth I MA 102664 INSPECTION RECORD RACTOR LICENSE E PHONE 15083264224 - FIELD COPY Date I .4— ote Progress - Corrections and Remarks I Inspector c L FA 40 oc TOWN OF YARMOUTH Building Department BUILDING " . " " (508) 398-2231 extt..226611 M PERMIT NO F6-07-237. ' ISSUE DATE ;. 811QMQQQ.: PROPOSED USE GG PERMIT APPLICANT ....e. Meyer' ... ' " " ............................. " ... " " " : JOB WEATHER CARD PERMIT TO Addition AT (LOCATION) 001728LUE ROCK RID ZONING DISTRICT R 40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1101.159 BUILDING IS TO BE: CONST TYPE 15 J LOT SIZE construct addition for bedroom bath & living area, renovate wasting interior as per plans dated =4M. REMARKS AREA (SO FT) ' EST COST ($ L OWNER ITricrnas Zum ADDRESS IS Richard Road SaM Yamauth MA 02664 PERMIT FEE ($) $257.00 BUILDING DEPT BY INSPECTION RECORD USE GROUP L-4 PHONE CONTRACTOR LICENSE 009813 Meyer, Charles 27 Packet Drive Dennis MA 02638 5083854421 FIELD COPY I Note Progress_ and Remark �' ILL . _-Il a• A ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOUSH A 0 I ANGF Town of Yarmouth Building Department 1146 Route 28 • Yarmouth, NIA 02664-4492 3111. Tel: (508) 398-2231 x261 • Fax: (508) 3 -0836 Office Use Only Planning Board Information Assessors Department Inforr Permit No. �" ate (o Ian Type iMap Z, / Endorsement Date .y ! Permit Fee $ ,t� Recording Date New Deposit Rec'd. $W,� Date PlannNN 14 r pertyDimensions: (�c Net Due $ ? j2, +ref Lot Arda (sf) Frontage 11),,., Lot Coverage / This Section for Office Use Only Building Per it be : I Datelssued: - Signature: ZMA8'- .p6 Certificate of Occupancy is is not required Building Official Date Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: t1a AIt,Q S. 1.2 ZoningInformation: —Zoning biiLstrictt Pr pos Use 44 1.3 Building Setbacks (it) Front Yard Side Yards Required Provided Required Provided. F cRirBI VcLdu 5 1 (C 1 A Water Supply (M.G.L c. 40. S 54) Public Private 1.5 Flood Zone Information: y/ _ l Com Zone: BFE: n : Ub I Ulu10� sr: Section 2 - Property Ownership/Authoriz 2.1 �nrner of Rec •7� �Gtr\RL Z��lK/1 r Name(g1Lng gd ress t Signature I ING DEMIephone 2.2 u rise Age Nam ( t UJ""X-O'5N446)1 R E C E -1Y ED Signature lephone r 9. 20D Secti a- Construction Sery es 1 3.1teftift'nstction pervisor: nBUILJD1NG!DEP , li able BY- 6G License Number 0) b ` I '1 �1 7 . , i /� ` QA4a A ess Expirati n Date nature Telephone 3.2 Registered Home Improvement Contractor, Corn any Name pp'.- j ; t7G1 I I Not A lic bl PP a q',0, License n— d A4' r( g ature Telephone ExpirationDat rj 1of2 • OvtH Section 4 = Workers' Compensation Insurance Affidavit (M.G.L. c.152 s 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure ' to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... Section 5 - Description of Proposed Work (c eck all applicable) New Construction ❑ No. of Bedrooms No. of Bathrooms Existing Bldg. Q--*l nepair(s) 53,ol Alterations Lr IAddition t r Accessory Bldg. ; ❑ Type Demolition Other Specify: Brief D scr pt o% Proposed Wolk:� a (I� r z A rT roc r 1 (' Costs Section 6 - Estimated Construction Item Estimated Cost (Dollars) to be completed by permit applicant Check. Below E onservation-Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if appli ble) nA 1. Building b 0040'' 2. Electrical ;Lb a oQsO. - 3. Plumbing / Gas 1 S bvt� 4. Mechanical (HVAC) is a &sa . 5. Fire Protection _ 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & additions) Section 7a - Owner Authorization - Owner's gent or Contractor Applies To be Completed When for Building Permit I, - ' ' "' hereby authorize w�" 1 7 , as owner of the subject property to act on may behalf, in all matters relative to work auth6ri ed by this building permit application. ` .. 2wzU SignatuPe of Ow Date Section 7b w er/Authorized Agent Declaration I, Win W'A , as Owner/Authorized Agent hereby declare that the statements nformation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Gha 6A) LL) .l�'la g,� :... ,. Prl5w.ameHW r f r W I ignature of Owner/Agent o f`.0 Date .' . 9-15-99 2 of 2 ' r TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: ��],` job Location: '[ d Numbe Owner of Property: ()%4 Construction Supervisor: L -r Ie N: Address: Licensed Designee: (If other than Supervisor) Name Rog, Street 2.15 Responsibility of each license holder: License No. Village License No. Phone No. 2.15.1 The license holder shall be fully and completely responsible for all work for which lie 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 Anylicenseewlio shall willfully violate subsections 2.15.1, 2.15.2 or2.15.3 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 tinder 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 I' ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes Zr No ❑ If you have checked M, please ia the type coverage by checking the appropriate box. ndic 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: or Owner's Agent Owner ❑ Agent Signatule: V 9AM�%J' VyV—d 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:AAA S 11hd'b�.iGhS Est. Cost ,CLb. ' Address of Work I T.� 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 fora 'aasthe agentof the owner: o . I ate Contractor Name Registration No. MA Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name The Commonwealth ofMassaehusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name Address: City/State/Zip:��11k 4 o�Cf3b Phone M �g• 2)rY Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I ejnployas (full and/or part-time).' 2. V am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. t These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. New construction 7. Veemodcling 8. ❑ Demolition 9. 524uilding addition 10.[�lectrical repairs or additions I I. Vumbing repairs or additions 12.f�4of repairs 13.❑ Other Any applicant that checks box it t must also fill out the section below showing then workers' compensation policy information 1 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. [Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the polity and job site information. Insurance Company Name: Policy # or Self -ins. Lic #: Expiration Date: Job Site Address: 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 $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 herefiy ^iCv ungerlhe pow and penalties of perjury that the information provided above is true and correct. Oricial 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. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #• Information and Instructions , Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defimed as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs.persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." , MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the Issuance or renewal of a license or permit to opeiate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the Insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), addresses) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cant' workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if YOU are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self -insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/liccnse number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any gtestions, please do not hesitate to give us a call. The Department's address, telephone and fax number: ; The Commonwealth of Massachusetts ` Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-OS www.mass.gov/dia F Y Temp Permit No.: Applicant Name: Applicant Phone: Building Location: Owner's Name: TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 wQ.261 BUILDING PERMIT TRANSMITTAL T-07-047 Charles Meyer 5083854421 00172 BLUE ROCK RD Thomas Zurn Owner's Addres 8 Richard Road South Yarmouth MA 02664 Owner's Telephone: REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 18444 Net Owed: ($25.00) Application Date: 7/31/2006 Issue Date: Expiration Date PLEASE NOTE SIGNATURE OF APPLICANT: Comments: Map/Lot: 101.159 construct addition for bedroom, bath & living area, renovate existing interior ZONINGS APPROVED DATE: DATE: DATE: DATE: DATE: DATE: MUM N/A: N/A: WA: WA: N/A: DATE: Date Printed: 8/1/2006 BUILDING TOWN OF Y A R M O U T H ELECTRICAL 1146ROUTE28 SOUTH YARAIOUTH b1ASSACHUSETTS02664-4451 GAS 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, iat th lbris stu�llttin�ro�m the proposed work/demolition to be conducted at 11 1 �`(1A , � PA Work Address is to be disposed of at the following location: ��►/� ^ Jul X4 Said disposal site sliall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. . U. Ar, Signature of Permit No. v �4 Da e To be completed by Applicant. Building Site Proposed TOWN OF YARMOUTH HEALTH DEPARTMENT G2T@rg nMRD PERMIT APPLICATION SIGN OFF TRANSMITTAL SB EEISUL 1 8 2006 HEALTH DEPT. '•Ifyou would like e-mail notification ofsign off; please provide e-mail address: Owner Owner Map No.: Lot No.: Tel.No.- •!Yoj'4%)l Filed: LT a Owner Tel. No 116 '3Lt Z RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit four (4) copies of plans, to include: (L) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note. Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: PLEASE NOTE COMMENTS/CONDITIONS: TE: % oG f�v5c 10 /�c vti0.4 k r /^�- J V'O avvi TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location: � Map #: Lot #: Proposed p vement: i(/1 �h -►� Applican • (A Address: �� ^�'� Tel. #:Y� SS 4A-)1I Date Fled: ��- RESIDENTIAL AND I OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location. Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc... Health Department Determines Compliance to Stat and town Regulations' Le., Requirements for Septage Disposal and other Public Health Activities. Fire Department: Determines Compliance to State and Town Requirements for Personal le� Safety, Property Protection; i.e. Smoke Detectors, Sprinkler Systems, Etc... DMSION: COMMENTS: OL.��EYL PLEASE N S r1 d/� Q�SI��LL //3�� Lt. Gd i D !4r 1 t.�1sT /o' Ta £ s7AII.2 c-r i1 s oale /VfDr//_ / /\ VeTrA, i A)7?/2 Date: TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664 Tel (508) 398.2231 — Fax (508) 398-w36 Town of'Yarmouth Conservation Commission Building Permit Sign -off Application Cons. Comm. Re Property Owner Construction Address: t, 12 n f j —rw�,'cLa- Assessors Map and P el: MAP PARCEL General Contracto Mtn Company Company Project Description: I,i' 6k-, hJnLk;6N/1-!t, A Contractor Plan Submi CONSERVATION COMMISSION Conservation Commission Filing Required: YES NO �j If Yes, Type of Filing: CdAf/ /� Notice of Intent Request For Determination Of Applicability Conservation Commission Sip -off Signature: Date: 2 — % 4� Printed on Recycled Paper w ■ /��Q��` ATTIC FLOOR BEAM D •�'•��f/AaYeafaea OVER BEDROOM#1 us2 iisi�'11359 ..asoaa23+2 PCs of 1 3/4" x 11 7/8" 1.9E Microllam® LVL Pagel Engine Versim 6.20.16 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED RECEIVED AUG 16 loos By. Product Diagram Is Conceptual LOADS: Analysis is for a Header (Flush Beam) Member. Tributary Load Width: 17 Primary Load Group - Residential - Living Areas (psf): 30.0 Live at 100 % duration, 10.0 Dead SUPPORTS: Input Bearing Vertical Reactions (Ibs) Width Length Live/Dead/Uplift/Total 1 Stud wall 3.50" 2.31' 2520 / 9201013440 2 Stud wall 3.50" 2.31' 2520 / 920 / 0 / 3440 Detail Other Al:Blocking 1 Ply 1 3/4' x l l 7/8" 1.9E Microllam(D LVL Al: Blocking 1 Ply 1 3/4" x 11 7/8" 1.9E MicrollamS LVL -See TJ SPECIFIER'S / BUILDERS GUIDE for detail(s): At: Blocking DESIGN CONTROLS: Maximum Design Control Control Location Shear (Ibs) 3358 -2811 7897 Passed (36%) RL end Span 1 under Floor loading Moment (Ft-Lbs) 11475 11475 17848 Passed (64%) MID Span 1 under Floor loading Live Load Deft (in) 0.329 0.342 Passed (U498) MID Span 1 under Floor loading Total Load Defl (in) 0.449 0.683 Passed (U365) MID Span 1 under Floor loading -Deflection Criteria: STANDARD(LL:U480,TL•L/240). -Bracing(Lu): All compression edges (top and bottom) must be braced at 9' 2" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing Is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANTI The analysis presented is output from software developed by Trus Joist (TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY] PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the TJ Distribution product listed above. -Note: See TJ SPECIFIER'S / BUILDER'S GUIDES for multiple ply connection. PROJECT INFORMATION: SANDY MEYER ZURN JOB 8 RICHARD RD YARMOUTH MA Copyright O 2005 by Trus Joist, a Weyerhaeuser Business Microllama is a registered trademark or Tres Joist. Bill Rubel Mid -Cape Home Centers PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net ATTIC FLOOR BEAM D • • • ��vAWrmluaww ae� OVER BEDROOM #1 u�z aes2i20 Serial :ia 3 .+70051759 2 Pcs of 1 3/4" x 11 7/8" 1.9E Microllam® LVL .Page2 Engine Versim 6.20.16 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Primary Load Group 13' 8.001 ^ Max. Vertical Reaction Total (lbs) 3440 3440 Max. Vertical Reaction Live (lbs) 2520 2520 Required Bearing Length in 2.31(W) 2.31(W) Max. Unbraced Length (in) 110 Loading on all spans, LDF - 0.90 , 1.0 Dead Shear at Support (lbs) 752 -752 Max Shear at Support (lbs) 898 -898 Member Reaction (lbs) 898 898 Support Reaction (lbs) 920 920 Moment (Ft-Lbs) 3070 Loading on all spans, LDF = 1.00 Shear at Support (lbs) Max Shear at Support (lbs) Member Reaction (lbs) Support Reaction (lbs) Moment (Ft-Lbs) Live Deflection (in) Total Deflection (in) SANDY MEYER ZURN JOB 8 RICHARD RD YARMOUTH MA 1.0 Dead + 1.0 Floor 2811 -2811 3358 -3358 3358 3358 3440 3440 11475 0.329 0.449 Copyright O 2005 by True Joist, a Weyerhaeuser Business Hicrollam• is a registered trademark of Trus Joist. OPERATOR INFORMATION: Bill Rubel Mid -Cape Home Centers PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone:508-398-6071 Fax :508-3984559 brubel@midcape.net • 0ex/��, RIDGE BEAM E f/A .reu ions OVER KITCHENILIVING AREA T.66eam® 6.20 Serial Number: 7005111359 User.2 81151200810:48:13AM 2 PCs of 1 3/4" x 14" 1.9E Microllam® LVL PagA 1 Enpine Versbn: 8.20.18 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Member Slope: W12 Roof Slope02 + 2111 All dimensions are horizontal. Product Diagram Is Conceptual. LOADS: Analysis is for a Header (Flush Beam) Member. Tributary Load Width: 6' 6" Primary Load Group -Snow (psf): 30.0 Live at 115 % duration, 20.0 Dead SUPPORTS: Input Bearing Vertical Reactions (Ibs) Detail Other Width Length Llve/Dead/Uplitt/Total 1 Stud wall 3.50" 2.60" 2129 / 1734 / 0 / 3863 Lt: Blocking 1 Ply 1 314" x 14" 1.9E Microllam LVL 2 Stud wall 3.50" 2.60" 2129 / 1734 / 013863 LI: Blocking 1 Ply 1 314" x 14" 1.9E Microllam LVL -See TJ SPECIFIER'S / BUILDERS GUIDE for detail(s): L1: Blocking DESIGN CONTROLS: Maximum Design Control Control Location Shear (Ibs) 3804 -3347 10707 Passed (31 %) RL end Span 1 under Snow loading Moment (Ft-Lbs) 20447 20447 27897 Passed (73%) MID Span 1 under Snow loading Live Load Deft (in) 0.644 1.075 Passed (L/400) MID Span 1 under Snow loading Total Load Deft (in) 1.169 1.433 Passed (L/221) MID Span 1 under Snow loading -Deflection Criteria: STANDARD(LL:L/240,TL:L/180). -Bracing(Lu): Al compression edges (top and bottom) must be braced at T 3" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -Design assumes adequate continuous lateral support of the compression edge. ADDITIONAL NOTES: -IMPORTANTI The analysis presented is output from software developed by Trus Joist (TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLYI PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the TJ Distribution product listed above. -Note: See TJ SPECIFIER'S / BUILDER'S GUIDES for multiple ply connection. PROJECT INFORMATION: SANDY MEYER ZURN JOB 8 RICHARD RD YARMOUTH MA Copyright O 2005 by True Joist, a Weyerhaeuser Business Wicrollame is a registered trademark or Trus Joist. OPERATOR INFORMATION: Bill Rubel Mid -Cape Home Centers PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net 16, RIDGE BEAM E ' ,• ttuaes OVER KITCHENILIVING AREA TJ-Be118 6.20 Serial Number: 7008111358 User.2 8115/2006 10:48:14 AM 2 Pcs of 1 3/4" x 14" 1.9E Microllam® LVL .Paps 2 Engine Venbn: 8.20.18 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Primary Load Group 21' 6.00` Max. Vertical Reaction Total (lbs) 3863 3863 Max. Vertical Reaction Live (lbs) 2129 2129 Required Bearing Length in 2.60(W) 2.60(W) Max. Unbraced Length (in) 87 Loading on all spans, LDF = 0.90 , 1.0 Dead Shear at Support (lbs) 1503 -1503 Max Shear at Support (lbs) 1708 -1708 Member Reaction (lbs) 1708 1708 Support Reaction (lbs) 1734 1734 Moment (Ft-Lbs) 9180 Loading on all spans, LDF = 1.15 , 1.0 Dead + 1.0 Floor + 1.0 Snow Shear at Support (lbs) 3347 -3347 Max Shear at Support (lbs) 3804 -3804 Member Reaction (lbs) 3804 3804 Support Reaction (lbs) 3863 3863 Moment (Ft-Lbs) 20447 Live Deflection (in) 0.644 Total Deflection (in) 1.169 PROJECT INFORMATION: OPERATOR INFORMATION: SANDY MEYER Bill Rubel ZURN JOB Mid -Cape Home Centers 8 RICHARD RD PO Box 1418 YARMOUTH MA 465 RTE 134 South Dennis, MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net Copyright O 2005 by True Joist, a Weyerhaeuser Business Microllam• is a registered trademark of Trus Joist. MAIN FLOOR B A • �� Bauora OVER M #3 TJ-Beam® 6.20 Serial Number: 7005111358 User. 811412000B:41:39AM 3 1/2" r.x 9 1/2" 2.0E Parallam® PSL -Pala 1 Enaina Veraimu fi.20.16 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED 0, ,© e Brio" t Product Diagram Is Conceptual LOADS: Analysis is for a Drop Beam Member. Tributary Load Width: 12' Primary Load Group - Residential - Living Areas (psf): 30.0 Live at 100 % duration, 10.0 Dead SUPPORTS: Input Bearing Vertical Reactions (Ibs) Detail Other Width Length Llve/Dead/Uplitt/Total 1 Stud wall 3.50" 2.12" 2310 / 837 / 013147 LI: Blocking 1 Ply 1 1/4" x 910 1.3E TimberStrand® LSL 2 Stud wall 3.50' 2.12' 2310 / 8371013147 LI: Blocking 1 Ply 1 1/4' x 91/2" 1.3E TimberStrand® LSL -See TJ SPECIFIER'S / BUILDERS GUIDE for detail(s): L1: Blocking DESIGN CONTROLS: Maximum Design Control Control Location Shear (Ibs) 3065 -2615 6428 Passed (41 %) RL end Span 1 under Floor loading Moment (Ft-Lbs) 9578 9578 13057 Passed (73%) MID Span 1 under Floor loading Live Load Deft (in) 0.420 0.417 Passed (L/357) MID Span 1 under Floor loading Total Load Deft (in) 0.572 0.625 Passed (L/262) MID Span 1 under Floor loading -Deflection Criteria: STANDARD(LL:L/360,TL:L/240). -Bracing(Lu): All compression edges (top and bottom) must be braced at 1 Z 10" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANTI The analysis presented is output from software developed by Trus Joist (TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, Input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLYI PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the TJ Distribution product listed above. PROJECT INFORMATION: SANDY MEYER ZURN JOB 8 RICHARD RD YARMOUTH MA Copyright O 2005 by Trus Joist, a Weyerhaeuser Business Paraiiame is a registered trademark of True Joist. OPERATOR INFORMATION: Bill Rubel Mid -Cape Home Centers PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net • ' �� MAIN FLOOR BEAM A r4W OVER BEDROOM #3 U-SeamA 6.20 Serial Numbor. t5111359 User.2 8114=6e:41:39An1 31/2" x 91/2" 2.0E Parallam® PSL • Pape 2 Engine version: 8.20.18 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Primary Load Group 12' 6.00• Max. Vertical Reaction Total (lbs) 3147 3147 Max. Vertical Reaction Live (lbs) 2310 2310 Required Bearing Length in 2.12(W) 2.12(W) Max. Unbraced Length (in) 154 Loading on all spans, LDF = 0.90 , 1.0 Dead Shear at Support (lbs) 695 -695 Max Shear at Support (lbs) 815 -815 Member Reaction (lbs) 815 815 Support Reaction (lbs) 837 837 Moment (Ft-Lbs) 2546 Loading on all spans, LDF = 1.00 Shear at Support (lbs) Max Shear at Support (lbs) Member Reaction (lbs) Support Reaction (lbs) Moment (Ft-Lbs) Live Deflection (in) Total Deflection (in) PROJECT INFORMATION: SANDY MEYER ZURN JOB 8 RICHARD RD YARMOUTH MA 1.0 Dead + 1.0 Floor 2615 -2615 3065 -3065 3065 3065 3147 3147 9578 0.420 0.572 Copyright O 2005 by Trus Joist, a Weyerhaeuser Business Parallams is a registered trade k of Trus Joist. OPERATOR INFORMATION: Bill Rubel Mid -Cape Home Centers PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone: 508-398-6071 Fax :508-398-4559 brubel@midcape.net FLOOR BEAM B 40A .n Barioe♦ UNDER KITCHEN/DINETTE AREA � ,°:noserial e 50:. �`+'�51158 3112" x 11 718" 2.0E Parallam® PSL, Wolmanized® - SL 2 (16% < MC Page 3 Engine Verson: 6.20.16 < 28%) THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Primary Load Group 11' 8.00- Max. Vertical Reaction Total (lbs) 3750 3750 Max. Vertical Reaction Live (lbs) 2040 2040 Required Bearing Length in 5.28(W) 5.28(W) Max. Unbraced Length (in) 144 Loading on all spans, LDF = 0.90 , 1.0 Dead Shear at Support (lbs) 1345 -1345 Max Shear at Support (lbs) 1663 -1663 Member Reaction (lbs) 1663 1663 Support Reaction (lbs) 1710 1710 Moment (Ft-Lbs) 4850 Loading on all spans, LDF = 1.00 Shear at Support (lbs) Max Shear at Support (lbs) Member Reaction (lbs) Support Reaction (lbs) Moment (Ft-Lbs) Live Deflection (in) Total Deflection (in) SANDY MEYER ZURN JOB 8 RICHARD RD YARMOUTH MA 1.0 Dead + 1.0 Floor 2949 -2949 3646 -3646 3646 3646 3750 3750 10634 0.224 0.552 Copyright O 2005 by True Joist, a Weyerhaeuser Business Parallams is a registered trademark of Tx -us Joist. OPERATOR INFORMATION: Bill Rubel Mid -Cape Home Centers PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net ROOF BEAM C •� � a om AT BEDROOM #2 TJ-BoaUser.2 B/Mo s oN.,Am5'�5111358 31/2" x 91/2" 2.0E Parallam® PSL - Pepe 1 Enpina Vanbn: 8.20.78 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Member Slope: OM2 Roof Slope6112 0, , 2❑ A-1Y 4" All dimensions are horizontal. Product Diagram Is Conceptual. LOADS: Analysis is for a Header (Flush Beam) Member. Tributary Load Width: IT Primary Load Group - Snow (psf): 30.0 Live at 115 % duration, 20.0 Dead SUPPORTS: Input Bearing Vertical Reactions (Ibs) Width Length Live/Dead/Uplift/Total 1 Stud wall 3.50" 2.86" 2405 / 1857 / 0 / 4262 2 Stud wall 3.50" 2.86' 2405 / 1857 / 0 / 4262 Detail Other L1: Blocking 1 Ply 1 1/4" x 91/2" 1.3E TimberStrandO LSL L1: Blocking 1 Ply 1 114" x 91/2" 1.3E TimberStrandS LSL -See TJ SPECIFIER'S / BUILDERS GUIDE for detail(s): L1: Blocking DESIGN CONTROLS: Maximum Design Control Control Location Shear (Ibs) 4146 -3513 7393 Passed (48%) RL end Span 1 under Snow loading Moment (Ft-Lbs) 12439 12439 15016 Passed (83%) MID Span 1 under Snow loading Live Load Defl (in) 0.388 0.600 Passed (U371) MID Span 1 under Snow loading Total Load Deft (in) 0.688 0.800 Passed (Lt209) MID Span 1 under Snow loading -Deflection Criteria: STANDARD(LL:L/240,TL:U180). -Bracing(Lu): All compression edges (top and bottom) must be braced at 12' 4" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -Design assumes adequate continuous lateral support of the compression edge. ADDITIONAL NOTES: -IMPORTANTI The analysis presented is output from software developed by Trus Joist (TJ). TJ warrants the sizing of Its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY[ PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the TJ Distribution product listed above. PROJECT INFORMATION: SANDY MEYER ZURN JOB 8 RICHARD RD YARMOUTH MA Copyright o 2005 by Trus Joist, a Weyerhaeuser Business Parallame is a registered trademark of Trus Joist. OPERATOR INFORMATION: Bill Rubel Mid -Cape Home Centers PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone: 508-398-6071 Fax :508-398.4559 brubel@midcape.net • ROOF BEAM C 'gin r~M AT BEDROOM #2 U �°? �:rzserial 1:+ AM 31/2" x 9 1/2" 2.0E Parallam® PSL ' Pape 2 Engine version: 6.20.16 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Primary Load Group 12' 0.00e Max. Vertical Reaction Total (lbs) 4262 4262 Max. Vertical Reaction Live (lbs) 2405 2405 Required Bearing Length in 2.86(W) 2.86(W) Max. Unbraced Length (in) 148 Loading on all spans, LDF = 0.90 , 1.0 Dead Shear at Support (lbs) 1530 -1530 Max Shear at Support (lbs) 1806 -1806 Member Reaction (lbs) 1806 1806 Support Reaction (lbs) 1857 1857 Moment (Ft-Lbs) 5419 Loading on all spans, LDF = 1.15 , 1.0 Dead + 1.0 Floor + 1.0 Snow Shear at Support (lbs) 3513 -3513 Max Shear at Support (lbs) 4146 -4146 Member Reaction (lbs) 4146 4146 Support Reaction (lbs) 4262 4262 Moment (Ft-Lbs) 12439 Live Deflection (in) 0.388 Total Deflection (in) 0.688 PROJECT INFORMATION: OPERATOR INFORMATION: SANDY MEYER Bill Rubel ZURN JOB Mid -Cape Home Centers 8 RICHARD RD PO Box 1418 YARMOUTH MA 465 RTE 134 South Dennis, MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net Copyright O 2005 by Trus Joist, a Weyerhaeuser 9usiness Parallems is a registered trademark of True Joist. N /F MACNIECE BENCH MARK--MAG. NAIL SET IN PAVEMENT= 43.61 ASSIGNED (21'-6- OFF HOUSE CORNER) 1 1� d301 PA QED / 2; J/e�Jy a- ....� �\,... f 41.vi , \� /29,200:62Ar 4le S.F. \n ' Vu N G BENCH MARK --TOP do CENTER OF WD. STAKE- 36.32 ASSIGNED (26' OFF HOUSE CORNER) 4A A 434 437 ,. J,7 43.- \\\43.V4 .7 • L.7 43. " O 10 a-� 4/ 41.4 rh ' TH 'L' C�gowmE) JUL 1 9 2006 N HEALTH DEPT. WORK MU CONFORM All TOWN ,.BYLAWSAMInlrru uue7F WEPT DA 1.34 • 2c'J, i N/F DOUGLASS DESIGN & CONS 1. DOWNSTAIRS BATH AND BAR PLUMBING WITH AN EJECTOR 2. UPSTAIRS PLUMBING TO BE F 3. REDUCE GRADES OVER LEACI- EXTRA PEASTONE TO MAINTAI Tl 1 I C` Ill A A I ♦ < ✓ TH 1 T - -E— 40.4 8 �- 0 REV. 11 /3j TEST HOLE LOCATION, NUMBER WATER LINE MARKINGS UNDERGROUND TELEPHONE MARKINGS OVERHEAD ELECTRIC LINES GAS LINE MARkINGS� EXISTING do PROPOSED ELEVATIONS ('X' MARKS POINT) EXISTING CONTOUR PROPOSED CONTOUR UTILITY POLE (IF SHOWN) EXISTING DRAINAGE CATCH BASIN FENCE (IF SHOWN, NOT ALL SHOWN) TREE (IF SHOWN, NOT ALL SHOWN) N /F DOUGLASS DESIGN & CONSTRUCTION NOTES I. DOWNSTAIRS BATH AND BAR SINK TO BE TIED INT( PLUMBING WITH AN EJECTOR PUMP. 2 UPSTAIRS PLUMBING TO BE PLUMBED OUT FRONT 3. REDUCE GRADES OVER LEACH AREA AS SHOWN, 0 EXTRA PEASTONE TO MAINTAIN 3' MAXIMUM COVEF THIS PLAN IS A VALID COPY ( AN ORIGINAL RED STAMP AND HEALTfi AGENT APPROVAL 0 J 1 BENCH MARK --TOP do CENTER OF WD. STAKE- 36.32 (26' OFF HOUSE CORNER) NED 40 I N /F 2tJ, MACNIECE J34 �"a��•e�r J� ep icp iP i��p 6 P 47,i BENCH MARK--MAG. NAIL SET IN PAVEMENT— 43.61 ASSIGNED 417 43` i0d 9u4 \ (2l'-6* OFF HOUSE CORNER) :,c \ O 17� fir;,:• JeP. b^ w� •\ �- • 43 A:� it \ t� 4-301 � •\1SJ tp /X•J'7c PA`�.��• T. ape VEL) %14.7 � 17 gRKly u / os� S 'Y 41 - 41.o �� L0_r 92 0 +1� ,29,200±S.F. 407 all ,09'< _ a BAlz1 40• PIPE E47 .. °J �/ 33.14 OYCEEILWATO WATER, UNE. 46 latlJ V \� 30 39.2 4-lop V: � \ 1, \\ WORK M BYLAWS L�( JUL 1 9 2006 ALL TOWN 7, Z DATE 4� 3 41. i N/F DOUGLASS DESIGN & CONS 1. DOWNSTAIRS BATH AND BAR PLUMBING WITH AN EJECTOR 2. UPSTAIRS PLUMBING TO BE F 3. REDUCE GRADES OVER LEACh EXTRA PEASTONE TO MAINTAI TUIC` r,l Akl , TH 1 TEST HOLE LOCATION. NUMBER ; • ", WATER LINE MARKINGS T— UNDERGROUND TELEPHONE MARKINGS — E — OVERHEAD ELECTRIC_ LINES , GAS LINE MARKINGS 40.4 EXISTING do PROPOSED ELEVATIONS ('X• MARKS POINT) - EXISTING CONTOUR gam— PROPOSED CONTOUR 0 UTILITY POLE (IF SHOWN) EXISTING DRAINAGE CATCH BASIN — -- FENCE (IF SHOWN, NOT ALL SHOWN) TREE (IF SHOWN, NOT ALL SHOWN) REV. 11/3/04--LEACHING MOVED 7 N /F DOUGLASS DESIGN & CONSTRUCTION NOTES 1. DOWNSTAIRS BATH AND BAR SINK TO BE TIED INT( PLUMBING WITH AN EJECTOR PUMP. 2. UPSTAIRS PLUMBING TO BE PLUMBED OUT FRONT 3. REDUCE GRADES OVER LEACH AREA AS SHOWN, 0 EXTRA PEASTONE TO MAINTAIN 3' MAXIMUM COVEF THIS PLAN IS A VAUD COPY ( AN ORIGINAL RED STAMP AND L� HEALT AGENT APPROVAL BENCH MARK --TOP & CENTER OF WD. STAKE- 36.32 ASSIGNED (26' OFF HOUSE CORNER) 419 N /F 1.34 MACNIECE \,� ,\ •334 \\ cos .�, ''*2? "o l@ lay.,`' e a3; � BENCH MARK--MAG. NAIL SET�e IN PAVEMENT= 43.61 ASSIGNED44 7 (21'-6- OFF HOUSE CORNER) \ 3at•.aIL 1 n r j 4301 \4A4 48,i4 A VEZ) q•03:10 Ile S USJT 92 - 1l C':t... fS.. 41t ,29,200FAA7 �� 40.3 \ .+• _ l 33.4 o wA42 8 411 c \ �� ' � i47• 42 `1 32 o' 0 �� DOUGLASS \ DESIGN & CONS �. kk JUL 1 9 2006 O \ HEALTH DEPT. 1' DOWNSTAIRS BATH AND BAR PLUMBING WITH AN EJECTOR / ,•a 3e 2. UPSTAIRS PLUMBING TO BE F Q WORK M T CONFOW M ALL TOWN 3. REDUCE GRADES OVER LEACF BYLAWS RE EXTRA PEASTONE TO MAINTAI YARM H WATM DEPT DATE TlJ I C` fl l A A l , * F = ✓ �C. \ \ `'. , LEGEND TH I. TEST HOLE LOCATION, NUMBER ' WATER LINE MARKINGS —T— UNDERGROUND TELEPHONE MARKINGS — E — OVERHEAD ELECTRIC LINES GAS LINE MARKINGS` 40.4 EXISTING do PROPOSED ELEVATIONS ('X' MARKS POINT) EXISTING CONTOUR g-- PROPOSED CONTOUR 0 UTILITY POLE (IF SHOWN) EXISTING DRAINAGE CATCH BASIN — FENCE (IF SHOWN, NOT ALL SHOWN) TREE (IF SHOWN, NOT ALL SHOWN) REV. 11/3/04--LEACHING MOVED 0 N /F DOUGLASS DESIGN & CONSTRUCTION NOTES 1. DOWNSTAIRS BATH AND BAR SINK TO BE TIED INT( PLUMBING WITH AN EJECTOR PUMP. 2 UPSTAIRS PLUMBING TO BE PLUMBED OUT FRONT 3. REDUCE GRADES OVER LEACH AREA AS SHOWN, 0 EXTRA PEASTONE TO MAINTAIN 3' MAXIMUM COVEF THIS PLAN IS A VALID COPY ( AN ORIGINAL RED STAMP AND HEALT AGENT APPROVAL mw ta) t514 r all, t4: -ZL 7z� rn (,vrfn� famf t ISM �►�r c�ac�c�� /v« MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 CITY: Dennis STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 7-17-2006 DATE OF PLANS: June 2006 TITLE: Mr./Mrs. Thomas Zurn PROJECT INFORMATION: Zurn/Harrison 172 Blue Rock Road South Yarmouth, MA COMPANY INFORMATION: Sandscape Building Co., LLC 27 Packet Dr. Dennis, MA COMPLIANCE: PASSES Required UA - 139 Your Home - 128 I I I I I Permit Y I I I I I Checked by/Date I I I Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 657 30.0 0.0 23 WALLS: Wood Frame, 16" O.C. 518 13.0 0.0 43 GLAZING: Windows or Doors 99 0.330 33 FLOORS: Over Unconditioned Space 657 20.0 0.0 30 HVAC EQUIPMENT: Furnace, 85.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determine ing the applicable Standard Design Conditions found in the Code. The HV C equipment se ected to heat or cool the building eftan 2 oftshall be no greadesign load as specified in Sactions 780CR 134 4 Builder/Design r Date ( d flIV It 111� a N m C) 6 m m C o C m v MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 hr./Mrs. Thomas Zurn DATE: 7-17-2006 Bldg.l Dept.l Use I I I [ ] I I I I [ 1 I I I I [ l I I I I I I [ ] I I I I [ 1 I I I 1 [ 1 I I I I I I I I I I I I I I ] I I I I ] I I I I I CEILINGS: 1. R-30 Comments/Locat WALLS: 1. Wood Frame, 16" O.C., R-13 Comments/Location WINDOWS AND GLASS DOORS: 1. U-value: 0.33 For windows without labeled U-values, describe features: Y Panes_ Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS: 1. Over Unconditioned Space, R-20 Comments/Location HVAC EQUIPMENT: 1. Furnace, 85.0 AFUE or higher Make and Model Number AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans I or specifications. 4 1 I DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: [ I I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: I I I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. I [ 1 I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I [ I I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.): I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-l" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I [ 1 I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): I I 1 I HEATED WATER I 170-180 1 140-160 1 100-130 I ----NOTES TO FIELD PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS 6 RUNOUTS TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 0.5 I 1.0 1.5 2.0 0.5 0.5 1.0 1.5 0.5 1 0.5 0.5 1.0 (Building Department Use Only)------------------------- A ADDRESS: Map / Lot: TOWN OF YARMOUTH BUILDING DEPARTMENT PLAN REVIEFV BUILDING PEtM1T APPLICATION RL'VUCW NOM �Eemir• cosT / Y- Data dInitial Rrmw: 8' —06 Ittspoctor. �� Correction moiME vo ce - A M or, N N.P.Izwe'm' ww*1 W.P"Ime! -Onx-9 L, oft; rj will Other �4 i a Special Pamir ft m the Zwft Board dAa=k BoiWh* Cade Dcaial (i[apptic") Z �� RECEIVED AUG 2 S 2006 BUILDING DEPT. o. ' 00 l LOT 92 29, 062.5 f S.F. G� o9 p 7'o �o �P�tH OF�y1 o ROBIN WILLIAM W1 COX Na 31341 TO THE BEST OF MY INFORMATION, KNOWLEDGE, AND BELIEF THE FOUNDATION SHOWN ON THIS PLAN HAS BEEN LOCATED ON THE GROUND AS INDICATED �� 08/25/06 EXISMG FOUNDA770VV ADD/A01V DATE PROFESSIONAL LAND -SURVEYOR 1 "AS -BUILT" PLOT PLAN SOUTH YARMOUTH, MASS. LOT 92, LC. PL 32679 DATE OBZ25AU SCALE 1" = of JOB 6427-00 CLIENT SANDSCAPE SWEETSER ENGINEERING 235 GREAT WESTERN ROAD PO BOX 713 SOUTH DENNIS. MA 02660 W8-396-3922 FAX 508-398-3083 C. I SR I PRa71 "27--00 1 drq 6927-cpp. DAV 0 2006 SAZ'TSER ENGIAMMrAra SIP f N �Pz TOWN OF YARMOUTH qo JA 1 BUILDING DEPT. Building L I1 rf AT: Location , Z a G L 1 Ln uLi APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By /I (f Fee: $ �s- c PERMIT NO. r` �^ t7S 7 S C� Date k 13 20�� Owner's Name �►�wf VVI �C--A XX Type of Occupancy (�w4- 1 PCI Now lans Submitted Renovation Yes El No El Replacement ❑ cf_v01��y a .� GJL�` y N y 0 Y > N O Z ,y N=¢ ~ 0 Y W 3 W Cr W Q to W Z CC f] a Q N Z¢ Q a a¢ Q 0 li ¢ W W x O Q O W 3= Q y a Z N 3 J Y N¢ a O ¢ y? J Z G¢ Q W 0 U. LL¢ Y W Q t Q= rn rn O Q ZQ OJ OJ Q¢¢¢ Q O Ix- l35 3 Y J m N o c g 3 O x W U. 0 Q m o SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) f� Installing Company Name 4 C 1y fhb� u� i,1� Address LI S 5ii im) Check One: ❑ Corp. ❑ Partnership A^ h d 2 G-13 Ei .Pit'm/Company Business ZleDhone 71 4 �Y�3 b 1111 Name of Licensed Plumber o ru < e-m:A± INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes ❑ No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of the Mass. General taws, and that my signature on this permit application waives this requirement. Signature of Owneror Owner's Agent I hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent ❑ Signature of Licensed Plumber i ayya3 License Number J Journeyman U� - Type: Master ❑ To n t �k descri �d, 0.`.`L61y nG J Owner or $1 Owner's Addres N -4 Is this permit in Purpose of Buil, PPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 RE C E IV E D (OFFICE USE ONLY) rMW ® s BUILDING I By: I•PE ALL INFORI By Fee: $ 6 7i,. 0) PERMIT Date: application the undersigned gives notice of his or her intention to perform the electrical 7.Z with a building permit? ❑ Yes Q Existing Service 0 O Amps /0W O New Service :L00 Amps 'L O Number of Feeders and AmDacity 0 —, el?o . S - LA ArL Telephone No. -1-t- �— ' to Box)[' �C�d�pwG ttI y Authorization �✓ 3 �l S,� / Volts Overhead ndgrd ❑ No. of Meters L Location and Nature of Proposed electrical Work: Comnletion of the follawine table may be waived by the lamertornfWire.c FixturesNo. of Rccc sed o a dl No. of Total Transformers KVA No. of Lijithtine Outlets No.. of Hot Tubs Generators KVA No. of Lighting Fixtures Above n- SwimmingPool md. ❑ md. ❑ o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. ot Vctection an Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat mp Totals: Number — — ons — — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Munic Local ❑ ipConnectioal n ❑ Other No. of Dryers 4' Heating Appliances KW g PP Security Systems: No. of Devices or Equipvalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. H dromassa a Bathtubs Y g No. of Motors Total HP Teleco. of evauons Wiring• No. of Devices or uivalent Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides roof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in and has exhibited proof of same to the permit issuing office. .Ic�CHECKONE: INSURANCE �� BOND❑ OTHER❑ (Specify:) 1 — q —07 Vo�� (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) ,l Work to Start: 7 — 10 — inspections to be requested in accordance wi4MECe 10, and upon completion. I certify, under the pains and penalties f perjury, that the infotmati on this aprue and complete.l�FIRM NAME: L-�CTjfL-1 L LIC. NO. I-7601 IVN Licensee: � A W 140 C F Signature LIC. NO. (If applicable, enter "exempt" in the license number lin Tel. No.:_,,� nl Address:%e1 1 hl GSWEA iL � & • 1�J� ��✓- It. Tel. No.: DOWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insura -e coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner ❑ owner's agent. ❑ Owner/Agent Signature _ [Rev. 03/00] '7V;502 Telephone No. I �nJ ...... :+..... �..�<<Q /(/►tl[// /1A/1�1/w-wrr C7 ►r .. vSO." �Nru7cVv ..�...r -- - E MPS - Permit Page 1 of 1 u ARA %IpMSTAR WPS - Permit Work Order Information Utility Auth/WO #: 01531152 Date: 07/13/2006 Company EILEEN CAREW Rep: ReportBy: YAR 172 BLUE ROCK RD ZURN MARTHA H Status: ACTIVE Service: RELOC Type: RES Nature of Work: RELO OH TO UG FROM POLE 449111. UPG 100- 200 AMP ADDNIG 2 ELEC RANGES, NO A/C, QUOTED FEE 250.00, PENDING INSP Service Informatio There is no Service Information. Permit Information Permit #: E07-039 Meters: 1 Reseal (Y/N): Y Date: 08/09/2006 Inspector: W10060 Description: �`8earoh [-Detail_Contacts NSTAS�-Home i!rl'S_Wfl4n wP.S H Gpm_ menu WOBequest Y.VP-"ews IaJ � Epp mil- $� O Copyright 2003 NSTAR, 800 Boylston Street, Boston MA USA. All rights reserved. Reproduction in whole or In part of any graphics, Images, text or other content at this web site must be granted by NSTAR, Boston, MA, USA. Unauthorized modification of any Information stored at this site may result In criminal prosecution. u http:Hwww.nstaronline.com/apps/wps/wpspermit. cf m?Page=Permit&Un ique= { ts_'2006-08-... 8/9/2006 RE -INSPECTIONS 1ST RE -INSPECTION - 2ND RE -INSPECTION - 3 OR MORE DUPLICATE - WEATHER CARD ECEl,�ED qN By: $30.00 $40.0 `'G�; �, $50.00 �oo� C $25.00 /// Z,�-7 DATE: ADDRESS: I%Z 4,6� ISSUED TO: �� ' REASON FOR RE -INSPECTION: /gyp ,_�f BUILDING DEPT.: 'ELECTRICAL• - U% o Ql FIRE DEPARTMENT: GAS: OCCUPANCY PERMIT: PLUMBING PERMIT: OTHER: I I I I I I I I I DECK �n�", 2-2"5'-10" 4'—p., I I a, I I FWG6068R 244CW6050 x 4'-11%" I - 1 I �� -I---- I i o f `— � 1 ova — IIx_ --; I xi In YJhII$ I ; - i e I in Walls II : m KI C EN f TO N F YARMO_UT_H _ �� Va I I e y REVIE WED F S OR OMMI �ONING CODE C01` r� I N —s� ,I in I I I Q � N11CANT F OM THE RE� VE 7HE I I I / / nCe061PLIANC . T + y. I I I ob t / CENTER UNE pF TE: �� III + SUPPORTING RIDGE.O o d SIZED BY OTHERS ING FFIC I m NEW FLOOR TO PATCH �IOSTING FLOOR HEIGHT O I � 7x4 s pport I 830D_ 3' 0\\ I I Post e ° . o H L N �,—< BACK � I —Val_ ley I i� I I ENTRY A ------------- I I X4 Support Post\\\ f r, — �I �' I BEDROOMS tt MI _ 2'-s' _ \ R move Existing TUB CU /� zT 1 J7 mall-m SIZED BY OTHERS aT N 1 ---- — --- 2s— — — — — —- - aise E— —xist—in oor— — — — — — — — — — x i • � N I t° to Match Ent y Wosh ( io "\a Laun 0 I I - ' Remove I � v LO BATH �ji existtna walla—��I ( —� ROOfr - - Set INE � I Irl I I x . .. 7 —10? I � Pat ----J- , A1��51 JN251� e--------- 2'-2 2 —9 2 —2 STEP v , STEP >E 1 2 -0 � I 8"x8" block I as fire stop under new wood wall ------------------ I I 0 a i rn x c:) in U.7 =A CV a Cd 00F; O iD cV O L0 n rei Yarmouth Health �Deepartrr•cia APPROVED D l% 7 Naine Date OFFICE MEETING NOTES ADDRESS: Names of Attendees:- ram Zoning District: Flood Zone: C Meeting Topic: DATE: 7/17/2015 SlipGen- Portal Hone Town of Yarmouth Template [Building Dept] Slipsheet Identifier [sg33543] Document Category Building Permits Map -Block Number 101.159 Street Number 0172 Street Name BLUE ROCK RD Department Building Parcel ID 13595 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2015-07-17 - 11:57 httpJAaser1lche12/S1ipGerV 1/1