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Home My WebLink AboutBLD-93-588 . , •i;-9.4 asL4 dr//� : 40' ' TOWN OF YARMOUTH v K rad r/'-/i3 t MAT ;,'HL 4!- `� , 4^ �,��o. 5�d'; Application for a Permit to Build No. UPON FINAL APPROVAL . MAP 4 LOT h g3 • • FEE MUST ACCOMPANY THIS AFFIXATION., DATE er 19I-3 The undersigned hereby applies for a permit to build rAl93 according to the following specific-tion ' 3� - 16�JZ . Name of property owner rhe C _ Tel. 8 ,+ Address es 0'1 A - S a.. G . • ..• 2.Name ofArchitect(if any) — Tel. V3. Name of builder,�Kfl2S �• M�Gra�'1'1 Address 120 6tethe o.. reed' -- 4. License No. 046-12' Tel. -7 6O ~ 1 5. Name of Mason Address p. License No. ""' Tel. j, . V � 7. Construction address 32 6 c 40n t n t)-e , 9cA o"" '/' , Flood - District � 8. Date of subdivision Approval plain Zone IQ yo �' 9. Private dwelling 0 Estimated Cost Q � . � DO NOT WRITE IN THIS SPACE gto — V N� /o n 0 Type of room No. 10. Multi family 0 11. Commercial 0Vt`/S //77 95 Kitchen 12.Other ..-":Xe---- --- - 5 , DininnKii g Rm. 13. No. of stories Living Rm. , Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 ,; (11' ' ' Bath 15. Materials — Wood 0 Cement 0 Other ❑ : l0 , a 0 Deck 16. Type of heat — Oil 0 "Gas 0 Electric 0 Other ❑ Closed porch 17. Garage — 1 ❑ 2 ❑ I /p , a U Family Rm. Sun room 18. Swimming pool - Size Garage /19. Storage shed — Size PDS( BP • 1 Shed gig g" /• 20. Stove Wood 0 Coal 0 , Alterations 21. Size of lot: No. of feet front No. of feet rear ' No. of feet deep I • S 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 r ar lot line �J.y�, Side line ,�r'C-', �. 3 7 `f �l LSi Signature/ i ,%�,1!�G%'(///� 4 �� ' LOT RELEASED BY g 1 PLANNING BOARD Address /Zo 6rto -1- nev Date -3 Dal v115• Wit. r5Z6 CO f I ' 1'.' 7/ae7 /93 _ _ . TOWN OF YARMOUTH BUILDING DEPARTMENT ,.' CONSTRUCTION SUPERVISOR FORM ' 2 PLEASE PRINT: / C � �p ( ] /) JOB LOCATION: SZ6 91 - � S .c_a-rn�` NUMBER , �{ TREET VILLAGE OWNER OF PROPERTY: JAMES �f 1' `y�C^�/ � ��,� c • CONSTRUCTION SUPERVISOR: JAMES 7J , ' ► `C&eT/� Q�J 13 c /60fY3 NAME LICENSE NO. C PHONE NO. ADDRESS: I Z t O Vc rA# c- ea . s ttnn'v HA- czeed i i LICENSED DESIGNEE: (IF OTHER THAN SUPERVISOR) NAME LICENSE NO. il 2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: 2.15.1 THE LICENSE HOLDER SHALL BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH 1 IS SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THEST. BUILDING CODE AND THE DRAWINGS AS APPROVED BY THE BUILDING OFFICIAL • �A. 2.15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTIOI 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 TH` COMMONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB- CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. 2.15.3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE DISCOVERY OF ANY VIOLATIONS WHICH ARE COVERED BY THE BUILDING PERMIT. 2.15.4 ANY LICENSEE WHO SHALL WILLFULLY VIOLATE SUBSECTIONS 2.15.1, 2.15.2 OR 2.15.3 OR AN OTHER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL BE SUBJE TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. 2.16. ALL BUILDING PERMIT APPLICATIONS SHALL CONTAIN THE NAME, , SIGNATURE AND LICENSE NUMBEF THE CONSTRUCTION SUPERVISOR WHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECC STRUCTION, ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.1 OF THF CODE AND THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERV: SAID PERSONS, THE WORK SHALL IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITI ON THE RECORDS OF THE BUILDING DEPARTMENT. I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS FOR LICENSII STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UND: THE CONSTRUCTION INION PROCEDURES AND THE SP CIFIC INSPECTION AS CALLED FOR BY THE BU, OFFICIAL. 21 SIGNATURE: BUILDING OFFICI• -PROVAL: - ' . BUILDING PERMIT APPLICATION SIGN OFF APPLICANT: Arthur 0V-tr_rA^ BUILDING PERMIT #: ADDRESS: 326 s1/2-0,,c\--on fru-e. TELE. NO. : 3'8^ 1652 DATE FILED: e( BLDG. SITE LOCATION: Y MAP#: �� LOU: A gir THE FOLLOWING INFORMATION OUTLINES THE PROCEDURAL STEPS REQUIRED TO OBTAIN A PERMIT TO BUILD, ALTER, OR ADD TO A STRUCTURE WITHIN THE TOWN OF YARMOUTH. THE BUILDING DEPARTMENT WILL DETER- MINE COMPLIANCE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APPLICANT THOUGF THE FOLLOWING DEPARTMENTS: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: DETERMINES COMPLIANCE OF WATER AVAILABILITY. ENGINEERING DEPARTMENT: DETERMINES COMPLIANCE FOR PARKING AND DRAINAGE. CONSERVATION COMMISSION: DETERMINES COMPLIANCE TO WETLANDS ACTS, I.E.: IF LOT(S) BORDER ANY TYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS, MARSH LAND, ETC. HEALTH DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, Z.E. : REQUIRE ) MENTS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES. FIRE DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REQUIREMENTS FOR PERSONAL SAFETY, PROPERTY PROTECTION, I.E., SMOKE DETECTORS, SPRINKLER SYSTI ETC. THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOI ISSUING THE REQUIRED BUILDING PERMIT: 'P REVIEWED BY: • 1. WATER DEPARTMENT DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE • ALL STUMPS AND/OR BRUSH MUST BE DISPOSED OF AT AN APPROVED SITE. A SIGNED RECEIPT FROM THE DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING PERMIT. COMMENTS: BLM/89 -, _—; ; _' _- `�. R' - COMMONWEALTH OF MASSACHUSETTS .. DEFARTMTNT OF INDUSTRIAL ACCIDENTS _.-_ -- _, _- _ ;G00 WASHINGTON STREET ,lames J Campoelt BOSTON, MASSACHUSETTS 02111 • romp.sstone. • WORKERS' COMPENSATION INSURANCE AFFIDAVIT • SAO (licensee/per-mince) #' (/✓� CC • with a principal place of business/residence art • 120 Sr i- bue6 -�-tereco s , .� nis . . (City/Sure/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 /1-1:-TA) A- co6coo72,36i 4s--8 c A-A- . Insurance Company Policy Number [ ) I am a sole proprietor and have no one working for me. - O I am a sole proprietor, general contractor or homeowner (circle one) and have hired mire contractors listed below t who have the following workers' compensation insurance policies: Name of ContractorInsurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Numb:: 0 I am a homeowner performing all the work myself. • NOTL•.Plerse be aware that while homeowners who employ persons to do maintenance.construction or repair work on a dweiiicz of not more than tare: 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 unitrnand ant a copy of his statement will be forwarded to the Department of Industrial Aecdenn' Office of insu ane for mvera e verifies::on and :ha:failure to se_urc coves^, as reeufr d under Sc mon 2511.01 MCI. 152 can lead to t..: imposition of criminal penalties censrs:ng of: fine of up to 5:500.00 and/or imprisonment of up to one year and dvil penalties in the form of:St::Work Order and 2 fine of 5100.00 a d:v against m:. Signed this davor 7/291� q:Th • . _,_ : '_ •-ems -_. Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use only NAME OF CITY/I.OWN Permit No. Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL a 142A requires that the"reconstruction.alteration.renovation.repair.modernization.conversion.inprovement.remo'al.demolition. or construction of an addition to:Inv prectastrg owner-occupied building containing at least one hut 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: ` >\E"\Qn�dien Est. Cost BCC Address of Work 2? 6 _ n Ai }- Owner Name: Air-Thu{ —71_ `C LTo n Date of Permit Application: ( ;7G -q I hereby certify that: Registration is not required for the following rcason(s): • Work excluded by law ,Job under 51,000 _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 cnt of the ow. 'r• • `7 - 7q -93 $1 44 aifi / Oc37V Date ntractor N• e Registration No. OR: Notwithstanding the above notice. I hereby apply for a permit as the owner of the above property: Date Owner Name PLOT PLAN FOR LOT n Indicate lecatcn cf garage or accessory building • Additions with dashed lines • Sewerage disposal (cesspool) Ea Well p • I (lot ft. rear) I Cr kbuttor's L9� } Abuttor's Vame Name Lot fl NAP I Lot # REAR YARD f this is a �I: If this is orner lot, 3 ft. corner lc trite in name \ � write in )f street. I t name 'of • Ic other u 0 v s=eet. o t JJ J • w y SIJ:. .n.. -nrass Yn:t.. HOUSE 0 FT. 0 o --- - - =O • . •Q • I SET BACK • o ( ft. c -. . I -0 (1-r. fes. frontage) \ /326 3 IST ION; . Aur, i (NAME OF STREET) / \ (96,i eitidaft ei_______. / \