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HomeMy WebLinkAboutBLD-93-592 $s %, TOWN OF YARMOUTH o K So tett et, daj 4 4.451 66g; Application for a Permit to Build No. g UPON FINAL APPROVAL I/ �� MAP � 7 LOT Z - /'51;) FEE MUST ACCOMPANY THIS APPLICATION: i,'1 -', ;1.i.ile ,' DATEti°� U/ cc' 19 93 The undersigned hereby applies for a permit to build /,/% according to the following specifications ."' 9 /1. Name of property owner C`%tZaii '` ' ' ' - ' Tel.3tR'SsI Address /o Fr f e a • � '., 6,7'> 2.Name of Architect(if any) • ll • ' i . Tel. 3:Name of builder /17.!171! A l ' ' ' : Address 4. License No.1 Tel. 5. Name of Mason ' • .-, 14. • -:'rt to ' ._i Address 6. Lice seNo. ' - '4/ Tel.' :' r c k+,t; ,,., ;: 1r" j ",._ . onstruction address /d r ' e a"c"''n'v `°i :'s. ` " 'S, / Floods District 8. Date of subdivision Approval $ plain zone • Zone R �b 9. Private dwelling 0 . Estimated Cost ,,.. W."`. DO NOT WRITE IN THIS SPACE • •Recall/O-�Le Type of room No. 10. Multi family 0 /on'•fr.) 49' ' ' 8/3/93 11. Commercial 0 d , _ • tKitchen 12. Other ❑ �� , °.:•'' ©1 as Dining Rm. 13, No. of stories — / 0 't"O'• y Living Rm. „ —Bed Rm. 14. Foundation — Full 0 Half ❑, Crawl 0 Slab C1'• - • ' - Bath 15, Materials`— Wood Ei 'Cement"D'Other ❑ ''w:''•':• -::`` ©' . Deck 16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 . Closed porch 17. Garage — 1 ❑ 2 ❑ Family Rm. Sun room 18. Swimming pool - Size _ _ Garage • 19. Storage shed — Size �u/Of Shed ala 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 Nocof feet rear- 23. ear23. 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 LOT RELEASED BY Signature P--00,_. t _12.._._ PLANNING BOARD Address Date Ff-3 - ? 3 sahhs Sts • TOWN OF YAMOUTII BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE S' _ 3 - y3 JOB LOCATION /p r 'gag cog) NUMBER STREET ADDRESS SECTION OF;TOWN "HOMEOWNER" "-dam/ •74- 1 dt M 76./ c=g 3 98' 5& L1 NAME HOME PHONE WORK PHONE PRESENT MAILING ADRESS /09' e a C e -. S • S . Va. nbv-+h ma5s . K3266V 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/SUE 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 SUCH 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 REQUIREMENTS. • HOMEOWNER'S SIGNATURE 74,1_,4,NC 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 'zbility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked its. please indicate the type coverage by checking the appropriate box. A liability Insurance policy a Other type of indemnity 0 Bond 0 • OWNER'S INSURANCE WAIVER: I am aware that the licensee does nct have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature cn this•permrt application waives this requirement. Check one: <� q Owner ® Agent 0 r i(.t'�.cHM . Signature of Griner or er s gent . - ___ -•- - PL T At . FOR LOT # Indicate locadcn cf garage or accessory building • Additions with dashed lines • Sewerage disposal (cesspool) e Well 0 I (lot ft. rear) I —_ — -- - Cr if i/it o ad. • — — _ _ 4buttor's I /yei 3ie Abuttor's \lame U 'I- 1 Name Lot # ..(4._) Lot # REAR YARD ai :f this is a If this is orner 1ot, , ft. corner k*trite in name write in )f street. • I e I name 'of • I other u 0 a st=eer. u ,o J • 4 y SID= YARD SIDE YARD HOUSE 0 F7. 0 --- - - _ . '/3' L".• • \ I rfjI �CI ri I \ SET BACK ft. . o I c Cr (ot /as-/ ft frontage) • \ / > /de AS acovj 5-1 \ / \ / (NAME OF STREET) \ / / \ L-`:—a_: • • P, — E COMMONWEALTH OF MASSACHUSETTS _e C • DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET • JamesCamooei, BOSTON, MASSACHUSETTS 02111 ' Comm:sstonet WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • • 1, ad)., ./A (licensee/permittee) • with a principal place of business/res dente ac /oR 1;P. AG, ^A 4 s• vs.-- vr, m014 mPS'S, 4V (Ciry/Srate/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 ( J 1 am a sole proprietor and have no one working for me. ( ) I am a sole proprietor, general contractor or omeowner circle one)and have hired the contractors listed below who have the following workers' compensation ins policies: • - Name of Contractor . Insurance Company/Policy Number . . . • Name of Contractor - Insurance Company/Policy Number • - .. - • • Name of Contractor Insurance Company/Policy Number - /VI am a homeowner performing all the work myself. NOTE.Please 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(CL 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 lnsuranee for coverage 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 51500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day against me. Signed this citi dbo day of fief , , 19 q_ :3, i .5ee!Permir et LicensoriPermirror Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only NAME OF C1TY/TOWN Permit No. Date A1Er1UAVIT Home Improvement Contractor Law . Supplement to Permit Application • MGLe 142A requires that the"reconstruction.alteration.renovation.repair,modernization.conversion.inprovement,removal,demolition. or construction or an addition to any preexisting owner-occuoied building containingat least one but not more than.tour 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: 6 r4v a p Sb r d Est. Cost/re-o Address of Work. /p c{ )j P a c c K • Sf Owner Name: ,1crJivj � �o •".P S • • Date of Permit Application: 9 - '3 9.13 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 v-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: aft a - a . . IS Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: g- 3 - Q3 tokiti-K. Date Owner Na