HomeMy WebLinkAboutBLD-93-593 •
\, __Y a rfY�,
. � itr-ca
TOWik N OF YARMOUTH aK 6-1"g ��j3
• MATTAGM[ 5 4,J (6 3
4�.:. i Application for a Permit to Build No.
UPON FINAL APPROVAL evd ?1-173 MAP /03 LOT // 3V
FEE MUST ACCOMPANY THIS APPLICATION. DATE4t---191/
The undersigned hereby applies for a permit to build 9/93
1according to the following specifications �a7q/92
1. Name of property owner 17/3 //pi, � AIvLLE" / Tel.77J 2a9
Address r $T Uv a£/z ;c Sr.? fjt.ylyi:S
2.Name of Architect(if any) Tel.
a Name of builder O1.07'Zayt} Address
4. License No. Tel.
5. Name of Mason Address
9. License No. Tel.
V7. Construction address S 4--A 7 f/PX V Al /f/C1i fief 4z'wa OM ncr
/8. Date of subdivision Approval plain zone Zonteict ,/a
9. Private dwelling 0 Estimated Cost
DO NOT WRITE IN THIS SPACE
3'93 W%,� �/ Type of room No.
10. Multi family 0 / 'AM • pa—
11. Commercial 0 p Six /is' Kitchen
12. Other 0 /• � a70, a-9— Dining Rm.
-- / 6 .0-t---4Ma Living Rm.
13. No. of stories Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath
15. Materials — Wood 0 Cement 0 Other 0 M/0/ Deck
16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch
Family Rm.
17. Garage — 1 ❑ 2 ❑ Sun room
18. Swimming pool - Size Garage
19. Storage shed — Size fhe /2-1 - 1 Shed g- -1t /
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 Signat rL e lc0 A �� �r
PLANNING BOARD Address d7/2c
Date t, eta/4;4/ >g4. Duo 6 r
-
/ 'W..3/ -1 .0E
TOWN OF YAMOUTU
BUILDING DEPARTMENT
HOMEOWNER LICENSE • or I'TION
PLEASE PRINT:
DATE 1 . 3 /?1
JOB LOCATION I A ,97-41. a /// 'E 'V Op se / ♦ .v a
NUMBER STRE'T ADDRES SECTION OF,TVV
"HOMEOWNER" 74 /40 , ()//e 7 ?3i Z 0 6 7 ''
1 NAME tt 0ME PHOIlE WORK PHONE
PRESENT MAILING ADRESS 3S /j/OACX/s S �/ ��vN(S
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 14110 DOES NOT POSSESS A LICENSE, PROVIDED THAT THE OWNER
ACTS AS SUPERVISOR. (STATE BUILDING CODE SECTION 109.1.1) •
DEFINITION OF 110MEOWNER:
PERSON(S) WHO OWNS A PARCEL OF LAND ON WHICH HE/SHE RESIDES OR INTENDS TO RE—
SIDE, ON WIIICII 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 THE BUILDING OFFICIAL,
ON A FOIL`, ACCEPTABLE TO TILE BUILDING OFFICIAL, THAT HE/SUE 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 iCepi
C
APPROVAL OF BUILDING OFFIC
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 currenyitThilfty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have checked y. 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 net have the insurance ccverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner 0 Agent 0
Signature of O+iner or Omer s Agent • -_ — _
PLOT PLAN
•
FOR LOT n
Indicate location cf garage or accessory building
•
Additions with dashed lines �Ly
Sewerage disposal (cesspool) ® 7'RMOUTI{AppROVEDOC�1
Well p YACOh1P,11TTEE
OK!] )
I (lot ft. rear) I
kbuttnr's \`1 . I Abuttor's
'lame ' Name
Lot q C . ei fl � Lot fl
REAR YARD
I this is a If this '
orner lot, ft. corner Ic
cite in name _- _ - - write in
)f steer. name 'of
other
-0 o street.
o
/J_ u
219let W""Ot
V
c
� I
-r"N i
SIDE YARDa
SIDE YARD
hi . iMeDHOUSE -- - - _-
G F- 0 a _ _ 10 •
Q .
I
SET BACK
ft. •
o� 'c
I —
Ce
$ - (lot f` frontage)
ry *.
tn Ni • -
_
tt.
C
PleittlIRI
lial
themsot
I --/ >- /
\ �. (NAME OF STREET)
\ \ I3 7,J .
U
a_
•
, Suggested Affidavit for Home Improvement Contractor Permit Application
. _-- _-Par Office Ilse Only -. __ . NAME OF CITYITOWN
Penult No. ---- -- - - .
Dnle - - - .
AFFIDAVIT •
Home Improvement Contractor Law
•
•
Supplement to Permit Application
MGL c.142A requires that the"reconstruction.alteration.renovation.renair•modernization.conversion.inprovement•removal.demolition. .s
or construction elan addition toanv preexist tug awner-o ccuniedcontainine at least one but not morethan fourdwellinq units....or ••
to structures which are adjacent to such residence or huildinr;"be done by registered contractors,with cenain'ececptions,along with other
requirements.
•
Type of Work: ta511/5-2). Est. e
/�Y/9Cost /)_-
-
•
Address of Work 3 4" rN.gx y,/ ,L yA,cev
/arret %`—
Owner Name: d-Fsf if A E i" o it-- y
•
Date of Permit Application: C,(�(,(q , 3rd 1C/93
I hereby certify that: I •
•
Registration is not required for the following reason(s): •
_Work excluded by law
Job under SI,000
—
!ding 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: •
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
D1:' 1 �973 l \ caner :.e
v.
COMMONWEALTH OF MASSACHUSETTS
r = DEPARTMENT OF INDUSTRIAL ACCIDENTS
600 WASHINGTON STREET :-
JzmesJ Camvoel: BOSTON, MASSACHUSEI IS 02111 •
Co mss one WORKERS' COMPENSATION INSURANCE AFFIDAVIT •
/ —)2fahi
(licensee/permi cc)
• • with a principal place of business/residence at:
•
S /tr4A41.(64/74.
(City/State/Zip)
do hereby certify, under the gins and penalties of perjury, that: -
I] 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 propricror and have no one working for me.
) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the cent;cors listed below
who 'nave 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 Number
a homeowner performing all the work myself.
•
NOTE:.Please be awue that while homeowner who employ persons to do maintenance,construction or repair work on 2
dweiiinz of not more than three units in which the homeowner Lisa resides or on the grounds appurtenant thereto are not generally
considered to be a tpiavers under the Worker' Compensation Act(CL C. 152.sect. 1(5)), application by a homeowner for 2 license
or permit may evidence the lecai situs of an employer under the Workers' Compensation Act
•
1 under::and :hat : ccpv of this st::crnea:will Sc forwarded to the C'ct r :neat of Industrial Acdden:a' Office of insu t'd for coverlet
vennc::pn m: en:: failure :p 'reside cover-re s renes:rap under _.-on
25A'of MGL 152 cn, lead to the i^position of ccira pen:)ties
consis:r.c of: ane of up to 5' cnn 00 and:or irnprso----t of up to one you end dtii pen:it:es in the form of: _ Work. Order and
fine o:5100.00 a day acains:^e.
Sicnec : sifif L� cave, C 7_ , 19 ?-3
• .�',:;; 11
2 ./'r* Old King's Highway Regional Historic District Committee
: i.,j ,. iNI In the Town of Yarmouth lora 3 %" /
a —'v~ i 1 CERTIFICATE OF APPROPRIATENESS 111 7
Application is hereby made in triplicate.for the Issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,
Acts and Resolves of Massachusetts. 1973.for proposed work as described below and on plans,drawings or photographs'
accompanying this application for. •
CHECK CATEGORIES THAT APPLY:
1.Exterior Building Construction: IiNew Building O Addition 0 Alteration I�H�
Indicate type of building:0 House 0 Garage 0 Commercial 0 Other
2.Exterior Painting: O
3.Signs or Billboards:0 New sign 0 Existing sign O Repainting existing sign
4.Structure: 0 Fence O Wall O Flagpole O Other •
(Please read other side for explanation and requirements).
TYPE OR PRINT LEGIBLY ` DATE //�
—9-9 3
•
ADDRESS OF PROPOSED WORK�J /CI1T/4{R.Cy/y 4/040961—' ASSESSORS MAP NO. C-�
>A a'YOU/870 Cr
OWNER —7AsLfh C M(/ IGE�/ ASSESSORS LOT N0111 •3Y
HOME ADDRESS SS WO KR IS ST. // 1/71 Arty /S TEL. NO. 77Sa 2,66p
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS.Include name of adjacent property owners across any public
street or way.(Attach additional sheet d necessary).
1177—fir
,3
/!' ebnnn TFn r_,
a : J YARMOUTH COMMITTEE
. II; - r,1 Cw.Pn9
—
AGENT OR CONTRACTOR"l TEL. NO.
ADDRESS LI ' n) '','1
LE.
_ —
n �x
DETAILED DESCRIPTIONOtPROPOSED WORK:Give ell particulars of work to be done(see No.8.other side),including
materials to be used. if specititations Co not accompany plans. In the case of signs, give locations of existing signs and
proposed locations of new signs. (Attach additional sheet.if necessary).
`
Signed (alai � � iltOwner-Cntr ctr-Acent
Stte below ins for Committee use.
•
-
- Received by H.D.C.
Date The
Certil c?tte.is hereb ') �"� Datel //
Time / ,i //01 /l// c )k ,� \
u: ,.1
:ac X0 !MPORTANT: If Cer:dicate is acproved.approval is subject to the 10 day appeal per:::
++11 provrcea in the Ac:. - .
se:preyed C Please return te: Ye:met:th Hls:c::c Cis:rtc:Comm::tee
T::.n HAIL. 11at Ht.25.Scuth Yar.-cu:h.Mass.0266.1 — y
r
i.:4 .P}
t / C ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATION
FOR A CERTIFICATE OF APPROPRIATENESS •r
The four categories for which a Certificate of Appropriateness Is required are: (application for demolition or removal Is a
separate form).
1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a
building to be erected or altered including windows,doors,siding,roof,light etc..that will be visible from any public street,
way or public place.The following scale drawings are required in duplicate with application:two plot plans(If addition-show
existing buildings in outline),four sets of elevations.Also required are snap shots of existing buildings,where additions or
alterations are to be made.No plot plan is required for addition or alteration which does not touch the ground.
2.EXTERIOR PAINTING:An application is required for any portion of a building,structure or sign to be painted that is visible
from a public street.way or public place.Color samples must be attached to these applications.An application is not required
when repainting existing colors,changing to white,or using colors approved by the Town Historic District Committee.
3.SIGNS OR BILLBOARDS:An application is required for any sign or billboard to be erected within the District,with the
following exceptions:
, a.'Existing signs or billboards on November 27, 1974 shall have until November 27, 1977 to secure an approved
Certificate of Appropriateness. --
b. Temporary signs for use in connection with any official celebration or parade or any charitable drive as long as they
are removed within three days of the event.Certain temporary signs mat the Committee feels toes not detract from
the Act may be allowed with the prior permission of the Committee.
c. Real Estate signs of not more than 3 square feet in area advertising the safe or rental of the premises on which they
are erected or displayed.
d. A single sign of not more than 1 square foot in area showing the name.cccupalron or address of the occupant of the
premises on which they are erected or displayed in a residential zone.
,4.STRUCTURE:An application is required to build or alter any structure within the District which is"defined by the Act as a
•combination of materials other than a budding,sign or billboard,but including stone walls,flagpoles,hedges,gates,fences,
etc.
GENERAL REQUIREMENTS
5.Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the
Town Clerk by the Committee.Approval is subject to the 10 day appeal period provided in the Act.
6.No changes shall be made from the original approved specifications without advance approval of the Commission on an
amended application filed with the Committee.
7.A separate application must be filed with each protect requiring a Certificate of Apprc:rrateness.
6. Uncer heading of "Detailed Description of Proposed Work- give detailed data on such architectural features as:
fc•;ndation,cnimney,siding,roofing,roof pitch,sash and doors.window and door frames,trim,gutters-leaders,roofing and
pant color,
5.finless application is complete and legible and all material required is supplied,application will not be accepted or actec
ectn.
Copies of the Act establishing :he Regional Historic District may be obtainec at the Town Hall,
O
so w
Cw): :xJ
rz f1 '
,D :7
m z
nr NJ fT1 41•
c:" A3 U
Q841O -4« tr
33111WW00 N1nOWatlx
Q3AON4d'1�1 `�
t
• i._
.i ;
/ X cr; scsD Nh/aAj • is IV
v Nese ssxbo tih/
g ivirwy tffi-i-PAD 4c N-,
Iitrg' 6'M1?1t/W Sc
A411N.ctt/X � l¢3Y Z' __Z. Off7 N
A2 zipp(ib/ , h W
/-11/119/41 N446/1/z Y // _1P-9,7y/1 'X LC&' T I IA/
'PK )1i-g/f4 8r 72cf4(s(13n/1Y_7/110/ Sf'lnI
'Ql11nQ v/ 7a.64/4 I✓/ywjey/ L uizg/c SI_;/ FG/ rO/
_;74.7277/7 LQ7 dPlhV
1 •
1
• I I .
• • ,7Ir.
• 2oC
phi ; 9istei. '93 JUL 2j P12 :21 i
;CNN 'P .r.1+ -
1OWNGU ii5...itRAM:I! II,
s l
i I +�, 1 ,
I 1
1 I 11 1
l"2ooPdr-in RrirrERA.I PT'O.G. I I 1 I c'eli. '
ii ,
nrt: Au- W000 r3 � I 1• ;
•
RU- 1D9MENSsONnL. ?1146 ■ , yk4 :7W QLAT $ I i I
ALL SHEDS !f/n✓Ey, Su1PvR? DACE I
64W C END LDUVE+2S . ; I 1
(Nuf sHow N0
Leak'SfLI ixv" PuRL1NS i I !
• I I I .
j � ti
I i I 1 i dAPPROVED
6•," pLywooD I ! iial,DUTHcommTTEE
2x4 Saar: rb•'o.G I ; OKNRD
. .alBLOCKING i ! _ ,.!_ ,
D It Qom_ e 1 I .
I i I
I j ' I
g q
•eX12 eve) l -f-ch , ! • 3 l
e. I iht
` Oat'
1RE.. ._ i , ED
L
7 ' 's
s
'93 JA 2n9 L P12:21
IS .. , 919" IO'WN OF YARN.!U1 i
;101YN CLERK & 1REASUF.(f:
fl
.
r I
12 I ' I I
. iI I I I i '
1 1 i
I"RooF oliva RAFTERS: W9..O.L. j 1 I IY 7N }
NorE: ALc. W000 r5 ' , ( I I I i
TILL 171MEN5,ONflt 1?n . : 9X4 :ne 4ATE$ I I L' i
' ALL SNEaS !fs}VEtz• 'AM Su1Pogr 134410Er; I :
611t3i-C &ND LOUVA-RSI•
; I I I •
CN(/r �N WN 4YiI .
0 CnRNC.R. ixv" PuRI-I1.4 i i 1 i i
post i I
' I ' YARMOUTH COIMAITiEE
�,•• QtywouD , I 1
ZYV soi6f4 I470.G I OKHRD;
.all BLOCKING
i 1 I
ex � Z even Pr +di i ; .g 71 1.7
OLD KING'S HIGHWAY REGIONAL HISTORIC DISTRICT COMMITTEE - - •
3kg7t
//�� M SPECIFICATION SHHT '
APPLICANT'S N, 1 1 FOR:
FOUNDATION: c1 $. -174" COLOR
=G: P.4-1.-52-- COLOR: pn c';-
vtica k :
CED EY: COLOR: •
ROOF MAT.EEflL: C ..1 PITCH:: 7/2- COLOR: nn ik
WINDOWS: I SIZE:
TPfl COLOR: wet43 -
DOORS: COLOR: teras2-.
c----43,5: COLOR: L-treS
CRS: COLOR:
•ii ifs- •
N L-ti.
N CE-
'DECK: it.:
a•- SIZE: COLOR:
°"' a! n^tl
t' ri rJ`
Gal.GE IDOORS r SIZ=: COLOR:
G; cn .-- z
rn ct
• o
STORM WINDOWS 6 DOORS: COLOR:
SKYLIGHTS (FIAT ONLY) SIZE: COLOR:
ADDITIONAL INFOR*'ATION: •
iIk1PPRO';.f pr�'i
OKF4RU
OLD RING'S EIGEWAY REGIONAL HISTORIC DISTRICT COMMITTEE -
39517
SPECIFICATION SHEET
• (�
APPLICANT'S NAME 6 FOR: 4 0
FOUNDATION: C�iN- r<-- COLOR
SIDING: Ret—let—c2-1 COLOR: eu97ts<-
-Q—.t
CEE NEY: COLOR:
ROOF MSTERI L: Gt.l PITC3: 7/2- COLOR: nn O-
WINDO'S: SIZE:
TRIM COLOR: 1.4)&1S--
02Sla
DO
MS: COLOR: ---�---...
: COLOR: Lc7"G
4s
C, N 'v
h: ,W
=2,5; , COLOR:
o
D=:\: SIZE: COLOR:
C; ca
"a
0
GATAGE DOORS:. "' SIZE: COLOR:
STORM WINDOWS E. DOORS: COLOR:
SKYLIGHTS (FLAT ONLY) SIZE: COLOR:
ADDITIONAL INFORMATION:
�.� Ooo wi
Virr, lit , , IP ..••• .---44%;1111W4-4,4 a d
R• e * VI' A. ,t, e .4 d • ° •V hA �j�Y(1
§ • cp i• t II. J _ *.� b ��, ❑
0 Q ! V N�i(� • .0 'r
,. : QP,\ O ��`O°.O' �Oir� A p�O Y"`� b' •
�_ =p
� :-X i'S\ s'� x'00, a i Q
En " A
• �� `�' °t 7 or �9 4`.� 4(:). A oA O �*
�°PSV 0 PHA • J7 .
nA w ``ra'9 O7n.4),.: \P 4� . �4 ` ►=t a4'p� rR :�
�.w{� te<>,
OO 14 Sh W ZA r R�10 O p� .44 O
R 4
r
I* ya •
O �� •s•
E4 • •O
��PQ ' R'� ��% y0 rA rx0 "0Oy�b O'‘ d '.A`AXAP , , A� a tt ' ti O �\ \ ��1j4'O y0 $� r 'P
\ "4. r i,. .._•
•
O
\\ XA ^o Oydy 38
re'� gr �\ \ yrs/ Pb O .-tj `M rc-,
EZ3 C:3
' g l° - 14 \ ^•„'� `' \ \\,
"Ao 0 0
. cil IM
:\,
•
\ \, i