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Home My WebLink AboutBLD-93-577 di'4 1 • o/\ ii Cd?-/7,1• --*• y �, TOWN OF YARMOUTH �7 t 4- H "k...:` Application for a Permit to Build . No. ��,•.��,; eSAINCoGic PORP �r UPON FINAL APPROVAL o�k, MAP // / LOT U l FEE MUST ACCOMPANY THIS APPLICATION. DATE VW i19 GIT (5i2-/?3 The undersigned hereby applies for a permit to build according to the following specifications 1. Name of property owner ALAggr PAy rt OckPAll r t vY Tel.s62..- Address '&S 461(44 �}111 f notal AO AM /020& 2.Name ofArchitect(ifany) Nib TeL 3. Name of builder N Efc- V'U& Address 4. License No. Tel. 5. Name of Mason Address 6. License No. Tellies 7. Construction address 4gr 1,4m— 5-r p naury Apr ,Iz'A Floo District F 8.Date of subdivision Approval plain zone G Zone I,- i 9. Private dwelling 0 stimated Cost DO NOT WRITE IN THIS SPACE nn � Type of room No. 10. Multi family 0 /0000 S ri.i (� 1 r e o room 11. Commercial 0 P_ 1 Kitchen 12. Other % c1 `(, ( Dining Rm. � nn Living Rm. 13. No. of stories C S/INIr C As— Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath 15. Materials — Wood 0 Cement 0 Other 0 Deck 16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 0 2 ❑ Family Am. Sun room 18. Swimming pool - Size Garage 19. Storage shed — Size Shed 20. Stove — Wood 0 Coal 0 Alterations 21. Size of lot: No. of feet front No. of feet rear No. of feet deep 22. Size of building. No. of feet front No. of feet side No. of feet rear 23. Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from line or street From rear lot line Side line 25. H.I.C.R. No. LOT RELEASED BY Signature Ii` � PLANNING BOARD Address al .51T- Date TDate Arir/GZiTf /040I a . • .2-4 TOWN OF YAMOUTH BUILDING DEPARTMENT HOMEOWNER LICENSE • a "TION PLEASE PRINT: DATE iilc't fig 3 JOB LOCATION 4gc 7ti; AIN ST V/ /wovra /der NUMBER STREET ADDRESS SECTION OF,TOWN "HOMEOWNER" Ac.BEaT afar 36a -1/406 ,_ NAME �7 HOME PHONE WORK PHONE PRESENT MAILING ADRESS 4//l 85 f'}l fl//V .5r plimvomi fir' /71, 0167, CITY OR TOWN 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 THE BUILDING OFFICIAL, THAT HE/SHE SHALL BE RESPONSIBLE FOR ALL SUCII WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1) 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 RE UIREMENTS. HOMEOWNER'S SIGNATURE aecrYt v APPROVAL OF BUILDING OFFICIAL 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 current liability insqraprce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 0 No If you have checked�s. please indicate the type coverage by checking the appropriate box. A liability Insurance policy 0 Other type of indemnity 0 Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the ad M s. General Laws, and that my signature on this'permit application waives this requirement. C eck ane: s Owner Agent 0 •. Signature ci OA-rer or r s AGent __ _ - — - -J _� • 'a. _ z. COMMONWEALTH OF MASSACHUSETTS � ';:r=` �' DEPARTMENT OF INDUSTRIAL•ACCIDENTS 600 WASHINGTON STREET James Canooe: BOSTON, MASSACHUSETTS 02111 • dorm:ssrone' WORKERS' COMPENSATION INSURANCE AFFIDAVIT I, _____"-/SEAT- GilAl (licensee ermtttccj • with a principal place of business/ esidenee an • ,4PS m4/v <STOr /19-P49(?"7-71 Acs S c067r ( iry/Scate/Zip) do hereby certify, under the pains and penalties of perjury, that: [] I am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number rem am a sole proprietor and have no one working for me. ( 1 I art a sole proprietor, general contractor o (circle one) and have hired the contractors listed below who have the following workers' compensation insuranc policies: Name of Contractor • Insurance Company/Policy Number .-- .. Name of Contractor Insurance Company/Policy Number - Name of Contractor Insurance Company/Policy Numb:: I am a homeowner performing all the work myself. NOTE.:.Plerse be :ware that while homeowners who employ persoos to do maintenance,construction or repair work on a dwciiine of not more than three units in which the homeowner also resides or on the grounds.appurcnaat thereto arc cot centrally considered to be erpiovers under the Workers' Compensation Act(GL C. 152.sec 1(5)).application by a bort owner for a license or permit may evidence the ler:.t status of an employer under the Workers' Compensation Act. I understand that : eepv of this statement will be forwarded to the Department of Industrial Auden_' Office chi insury & for coverage . . . vent�c:::p.-,, ane ._.. ._. .. :.� �c�• — ..m...- ....:cr: ::zce::e epve.�: as reeu:rc: under _.__on _,..of'.1Gi. 15=tr. lead ;,. ,... . pc:::pn of^ penatic ccnstsant: of a line of up to 5:500.00 and err imprt:onmct of up to one yea: and d}ii p nait._ in the farm of:5::: ::ori: Order and 2 fine of S100.00 a day again::me. /C Sig-._ this 17/ IIr N� dam ' o /�3 J •c 93 .liar #i . ^ Suggested Affidavit for Home Improvement Contractor Permit Application For orrice Use Only NAME OF CITY/TOWN Permit No. Date -- AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGLc 142A requires that the"reconstruction.alteration.renovation.repair.modernization.conversion.inprovement.removal.demolition. or construction of an addition to anv pre-misting owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building'be done by registered contractors,with certain exceptions,along with other • requirements. Type of Work: /1p Sc,_/ Est. Cost/0 C& — Address of Work fe /494///tom 3T / 'mour[� Po2 !1T 14 C�d�>j' --Owner Name: AL/iEir 6e4y' . Date of Permit Application: - tel 5 • c 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 Owner pulling own permit _Other (specify) Notice is hcrcby 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: • Notwithstanding3/___72_1 the above notice. I hereby apply for a permit as the owner of the above property: Arr Name .