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Home My WebLink AboutBLD-93-576 'k, c91.4 t 7/?o/52 •*-� : afo TOWN OF YARMOUTH 7/3x/75 oKFaW MATTAGXE � 4.....:_f Appikiati n #or a Permit to Build No._ Vi • UPON FINAL APPROVAL -1'--b - \MAP lib LOT E- 37 FEE MUST ACCOMPANY THIS APPLICATION. " DATE 7/3019 93 The undersigned hereby applies for a permit tobuild �J/3 3 according to the following specifications / 1. Name of property owner Ko-%r T11�.Pd. a , Tel. 7,0'/G S N Address 4.h � di./ La k7 , ywrrnovA. 2.Name of Architect(if any) Tel. �3. Name of builder nt,rallZR Address 4. License No. Tel. , 5. Name of Mason _ Address 1 - 6. License No. Tel. /, \7. Construction address '4u? en / 0 v-e- .1/7-0 ,tut-.' � OH Ai) , Floodistnct R rd 8. Date of subdivision Approval plain zone C- Z:ro 9. Private dwelling 0 Estimated Cost DO NOT WritTE IN THIS SPACE 1 f i L Tr> tom Na YC 10. Multi family 0 " .$ . a L. /eV /o '`- 11.Commercial 0 wL 5't - 4, 12. Other 0 - 13. No. of stories AC, o-e- 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 • 15. Materials — Wood 0 Cement 0 Other 0\ _ \ 16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch i, 17. Garage — 1 ❑ 20 FFamily un ily Rm. 18. Swimming pool - Size m Garage 9 X19. Storage shed — Size / o)CYC Shed /e Xia / 20. Stove —Wood ❑ Coal 0 `•I Alterations 21. Size of lot: No. of feet front1 No. of feet rear No. of feet deep 22. Size of building. No. of feet front No. of feet side Na of feet rear 23. Distance from nearest buildiric Front ' R.side Ft. side Rear 24. Distance back from line or street From rear lot line Side line 25. H.I.C.R. No. i LOT RELEASED BY /Signature _ .^ PLANNING BOARD Address _ r Cr? 0 tic/4t / No._Date 3_. �, \ dib � 1C k Ivry13e f LIQ FOR LOT n Indicate locat::cn cf garage or accessory building • Additions with dashed lines • , • Sewerage disposal (cesspool) e S9e11 p I • I I (lot ft. rear) I 4buttcr's I I Abuttor's 'Jame (, tuhl I Name Lot it I Lot It K-----bttfi¢_ - REAR YARD :f this is a ' Jo , I If this is crn er lot, , ft. corner kto in name write in a �f street. • I name .of t x I other u \ i_ -0 s:eec. ,o YYY a • e � cipr yA .. � HOUS= : . Q I 1 SET BACK C . o I c lI_. `0 • Cr.- f` f cntace) \ / \ yo L a,u-e r,& LO . LI ap.A.00t4IN / . / (NAME OF STREET) \ / TOWN OF YAMOUTH BUILDING DEPARTMENT HOMEOWNER LICENSE . . a ITION PLEASE PRINT:/ DATE 71 3j4,4s.:r LOCATION MBW .R ADDRESS U NUSECTION OWN ir HOMEOWNER" anzb t& 790 16 8. 1 771 ` Y 8bo HOME PHONE WORK PHONE RESENT MAILING ADRESS a,1142- fr------ lj IIA.7,4- , Grg-473 CITY OWN STATE ZIP CODE THE CURRENT EXEMPTION FOR "HOMEOWNER" WAS EXTENDED TO INCLUDE OWNER-OCCUPIED • - DWELLINGS OF SIX UNITS OR LESS AND TO ALLOW SUCH HOMEOWNERS TO ENGAGE AN IN- . DIVIDUAL FOR HIRE WHO DOES NOT POSSESS A LICENSE, PROVIDED THAT THE OWNER ACTS AS SUPERVISOR. (STATE BUILDING CODE SECTION 109.1.1) DEFINITION OF HOMEOWNER: PERSON(S) WHO OWNS A PARCEL OF LAND ON WHICH HE/SHE RESIDES OR INTENDS TO RE- SIDE, ON WHICH THERE IS, OR IS INTENDED TO BE A ONE TO SIX FAMILY DWELLING, ATTACHED OR DETACHED STRUCTURES ACCESSORY 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 TUE BUILDING OFFICIAL, ON A FORM ACCEPTABLE TO TUE BUILDING OFFICIAL, THAT HE/SHE SHALL BE RESPONSIBLE FOR ALL SUCH WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1) TIIE .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 e ( ti„z_ APPROVAL OF BUILDING OFFICIAL ,�/}`y_jejno_ • NOTE: THREE FAMILY DWELLINGS 35,000 CUBIC FEET, OR LARGER, WILL BE REQUIRED TO COMPLY WITH STATE BUILDING CODE SECTION 127.0, CONSTRUCTION CONTROL. INSURANCE COVERAGE: I have a curr n' liability insurance pclicyor its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ i If you have checked Vis, please indicate the type coverage by checking the appropriate box. I A liability Insurance policy 0 i Other type of indemnity 0 Bend 0 I OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. Gene Laws, and that my signature cn this permit application waives this requirement. Check one: Vii. ---- LOwnerAgent❑ . Signature ctr cr Owne Agent __ 4 Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use only NAME OF CITY/TOWN '.Permit No. Date • AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.142A requires that the"reconstruction.alteration.renovation.repair.modernization.conversion.inprovernent,removal.demolition, or construction of an addition to any pre-castingownerrecuoied building containing at least one hut not more than four dwdiing uniw....or to structures which are adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other • requirements. � ' Type of Work: /,,wZ- SA* '!) /4"),-/o Est. Cost 530, c -c Address of Work 70 ice( , !Lnol/ , —Owner Name: an/1441U V Date of Permit Application: yt J/9 I hereby certify that: Registration is not required for the following reason(s): • _Work excluded by law , Job under 51,000 _Building not owner-occupied X_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 I42A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: • Notwithstanding the above notice. I hereby apply for a permit as the owner of the above property: mn / ate carer ` .e COMMONWEALTH OF MASSACHUSETTS _ . DEPARTMENT OF INDUSTRIAL ACCIDENTS - }. - _=_ _:-• =: `-600 WASHINGTON STREET James Camooei, BOSTON, MASSACHUSETTS 02111 • ror-m:ss.one' • - WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • I LC\(.L'4'lr��n Pjn4rnd (licenscc/permiacc) (, • with a principal place of business/residence ant. • • C...------- (to kav,eirlo. A., 1,0, ya,ragvu.s/4. • 6 -673(City/Starcl ) . do hereby certify, under the pains and penalties of perjury, that: () I am an employer providing the following workers' compensation coverage for my employes working on this job. Insurance Company Policy Number JAI/1 am a sole proprietor and have no one working for me. O I am a sole proprietor, Ecncral contractor r omcowne (circle one) and have hired the contractors listed below ' who have the following workers' compensation insu ce policies: Name of Contractor • . Insurance Company/Policy Number ..-• .. Name of Contractor Insurance Company/Policy Number • Name of Contrctor Insurance Company/Policy Number XI am a homeowner performing all the work myself. • NOT:.Please be aware that while horceowocn who employ persons to do maintenance.codstruct on or repair work on a dweiiine of not more than three units in which the homeowner aiso resides or on the grounds appurtenant thereto are not centrally considered to be empiovers under the Worken' Compensation Act(GL C. 152.sec 1(5)). application by a homeowner for a license or permit may evidence the leersl status of an employer under the Workers' Compensation Act. I uncle^:and that a enpv of this statement will be forwarded to the Department of Industrial AcCdens'Office a insured for coverage vc-l:anon and that failure to tenure cove.ze as required under Scion 2.9.'ofMG. 152 can lead to the imnosi:ien of criminal penalties ccns6:.:c of: fine of up to Si 500.00 andlor imprisonment of up to one yet"and dvn pcneities in the form of :_:::Work Order and a fine of 5100.00 a day again::me. Sicr::d :his 10 dav of rant 7 t7 • G Vv '