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Home My WebLink AboutBLD-93-587 0/4141 Ws/p_g - 6 r TOWN OF YARMOUTH 14; iiitc e""x\\. rl 550 Application for a Permit to Build No. �g UPON FINAL APPROVAL fo R4"I3MAP /6 LOT AY FEE MUST ACCOMPANY THIS APPLICATION. DATE e/- 19 98 The undersigned hereby applies for a permit to build 5/.6/9' according to the following specifications 71. Name of property owner circ itt To.v?b' Tel. 775-' '/i7/ Address Sr ARI/-/G7 .'z/ (,d. Vsfarhsvrri m¢ 2.Name of Architect(if any) Tel. l/3. Name of builder 6£t) l/ErA( Address 4. License No. Tel. 5. Name of Mason Address 6. License No. Tel. 7. Construction address ?S- memit%.v 57 Lv-/Me Flood District ,i � - 8. Date of subdivision Approval plain zone Zone 9'c 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE STRi,,, Type of room No. 10. Multi family ❑, 1----Gsb, 06 .fiety 1 11. Commercial 0 �- L� �u�c� KitclSen 12. Other ,��TA i f �A� U /` Dining Rm. 13. No. of stories ?.500 Living Rm. �� Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 9tP a Bath 15. Materials — Wood 0 Cement 0 Other 0 tisD, a 0 Deck 16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 0 2 ❑ Family Rm. Sun room 18. Swimming pool - Size Garage 19. Storage shed — Size . ci- Shed 20. Stove — Wood 0 Coal 0 as, b ,,G6 wepg'�1. -Pic .4a4T 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 //SignatureJA-G " � PLANNING BOARD p/Address .3 4Icsd 't' r 77 Date M/. life, mg f . Suggested,Affidavit for Home Improvement Contractor Permit Application . . . .. For Orrice Use Only NAME OF CITY/TOWN Ferrell No. Date AFFIDAVIT . Home Improvement Contractor Law Supplement to Permit Application MGL e.142A requires that the"reconst ruction,alteration,renovation,renair,modernization.conversion.inprovement,removal,demolition. or construction of an addition to any pre-existing owner-occunied budding containing at least one hut not more than.four dwelling units....or to structures which are adiac h residence or building"be done by registered contractors,with certain ccceptions,along with other requirements. ``(( e of Work: / Est. Cost G _M.Wi- gg /77 •—Address of Work S—� ..— �s Avner Name: Q Bate of Permit Application: /sem// 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 ZOwner pulling own permit _Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING \VITH 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. . OR: ' Notwithstanding the above ennotice, I hereby apply for a ' as t ow/of the above property: 2-- GC Date Owner Name 1, • ;J.— • . =- —.. COMMONWEALTH OF MASSACHUSETTS '�' DEPAlr'MENT OF INDUSTRIAL ACCIDENTS ' • 600 WASHINGTON STREET . • amesQ Cat••••• BOSTON, MASSACHUSETTS 02111 . cpmetssioner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • (licensee/perminee) • with a principal place of business/residence an 3: Wiz/it/a'rm, S'i la. V,,,w, Aal, • (City/Bute/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 I am a sole proprietor and have no one working for me. [ ) I am a sole proprietor, general contractor •:rcle one)and have hired the contractors listed below e . : who have the following workers' compensation insurance po ides: -. . • :1, Name of Contractor . Insurance Company/Policy Number . _._ .. . Name of Contractor - Insurance Company/Policy Number • - . - Name of Contractor Insurance Company/Policy Number - - I am a homeowner performing all the work myself. NOTE:.PIeue be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally considered to be employers under the Workers' Compensation Act(GL C. 152.sect. 1(5)), application by a homeowner for a license or permit may evidence the legal status of an employer under the Workers' Compensation Act.. I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of lnsuranci for overage • verification and that failure to secure coverage as required under Section 25A'of MGL 152 can lead to the imposition of criminal penalties • consisting of a fine of up to S1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of$100.00 a day against me. Signed this C day o" , 19 l t Licensee Pcrmice_ OF / Licensor/Permiror ' TOWN OF YAMOUTII • BUILDING DEPARTMENT HOMEOWNER LICENSE • mPTION 4 PLEASE PRINT: DATE - , (iz6B LOCATION jar- ,9,QIY- 7ZA/ 6 i al. �`ira-RHeourevr NUMBER STREET ADDRESS SECTION OF;TOWN � g-V Hfon•e orIEOWNER"(o � e il -wet,be, 77 /.17/ y/3 - ,tsa-'-in 9,1 NAIIE HOME PHONE WORK PHONE �PItSENT MAILING ADRESS _F' ,9QLM'47 4./ S j ta, 1/4,,,A007-,9 /tint CITY OR TOWN STATE ZIP CODE • TILE 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, i 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 THE BUILDING OFFICIAL, . ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT TLE/SITE SHALL BE RESPONSIBLE FOR ALL SUCH WORK PERFORMED UNDER TILE 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 REQUIREM S AND THAT HE/SHE WILL COMPLY WITH SAID PROCEDURES AND REQUIREMENTS.9 / 4MEOWNER'S SIGNATURE 1.„4,... ,/ IP �� . 1 ,adAPPROVAL 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 insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ 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 ❑ Bend 0 4. OWNER'S INSURANCE + AIVER: I am aware that the licensee does not have the insurance coverage required by C 2 of t•e Ma/General Laws, and that my signature on this permit application waives this requirement. lir Check one: Owner 0 AgenttX . Si ()triers ___ — -_ 11 it � � Priggen Steel Building Co., Inc. General Contractors 13P Franklin °' Wrentham, MA 02093 (508) 384.7795 (508) 384.7130 Fax walls 9 woo efoummso ,-ort,_ aM41t43cw0WwMcMUIML 14 • _ LI31�3 5,4, . ; r L. T • tiL7),.....___, 1 6` w athri C. • • tv Etv. t tC N y„ �. 0. Ai Ili:n x. v c U j o, 1 r Z A rI .r.i • • .171 . b I, 0.4 t! CIS X E r I X14 alb ty ISS IV, UUP` CI 1 v P 30 ' d 8 £ : T T Q 3 M £ 6. - 0Z - 1. 30