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HomeMy WebLinkAboutBLD-93-595 M _ OFYAC 0 O �6/ .'` �, o- TOWN-OF-YARMOUTH erg �,� ?Ain\ A MATTACt_�';' ��,,��..,,..� Application for a Permit to Build No. 0 — ; UPON FINAL APPROVAL 0 q-10 -12,3 MAP IS LA "9 'FEE MUST ACCOMPANY THIS APPLICATION. DATE /v 19 '] The undersigned hereby applies for a permit to build I D f according to the following specifications 1. Name of property owner reID. I row}w,c,„, Tel. 398 85 04 Address 2'q "Old " Mar„ Si-recf- S YrA..o,.Ai, cia 2.Name of Architect(if any) Tel. a Name of builder Rickard Sehosk; _Address 10 Peeptccul Rd. Cairo;d& 4. License No. 00 9635 Tel. 9as'- 8'5'11 5. Name of Mason Address 6. License No. Tel. 7. Construction address o"t/y OLP /YMN 5 7-, S Flood District p�, 8. Date of subdivision Approval plain zone c- Zone gA-r- 9. Private dwelling 0 Estimated Cost -1/1;1f' DO NOT WRITE IN THIS SPACE 10. Multi family0 $eVrnrn_i- Fbc'1 Type of room No. 51/ y0007 — 74 . ) C� �,Nyiwc-j4) I 11. Commercial ❑ motive Gavin) 9 Kitchen 12. Other //a,rr- w4 2 Dining Rm. 13. No. of stories Living Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 5-0 r 0-0--- Bed Rm. Bath —15. Materials — Wood 0 Cement 0 Other 0 !O oc2 Deck 16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 / I re—' Closed porch Family R . 17. Garage — 1 ❑ 2 ❑ % Sun room m O►wimming pool - Size I X X36 (Tec4r,,,,5u14,-) Garage 19. Storage shed — Size Shed • 20. Stove — Wood 0 Coal 0 Alterations 1 `: 1,, 21. Size of lot: No. of feet front f 0 Z. S9 No. of feet rear f SV. 40 No. of feet deep f Sy, t,W `. 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 III' + From rear lot line 35 ' 4 Side line 3o ' + 25. H.I.C.R. No. LOT RELEASED BY Signature / ------ PLANNING BOARD • . . . Address I , Zig ad Man. S/. 5', t e.«ik-il-- s Date (n V/ I'/ APPLICANT: 1 i I r pk-km ei r BUILDING PERMIT s�: •R-..�-‘ ADLU:ES : 417 OR Mat.t S+, TELE. NO. : 374:11106 DATE FILED: M. BLDG. SITE LOCATION: CL.0'�' A i ` Z(q O(, mal„, MAPII: TS LOT/f: g 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 THOUGH 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, I.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 SYSTEMS ETC. THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR ISSUING THE REQUIRED BUILDING PERMIT: REVII•:WI' BY: ATR DEPARTMENT DATE: c 3 N/A: 2. ENGINEERING DEZ'ARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT iip o/ DATE: cc/9 3 N/A: I / /� STRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: G. 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: QQ n / 16 M. . � .*- Xtcl /3 4-°•!t aA 7,ac/vc- DO oiafiT i-°-t' ELM/89 ��4/93 TOWN OF YAMOUTH • BUILDING DEPARTMENT • - HOMEOWNER LICENSE E DATION , PLEASE PRINT: DATE (5) /r'3 JOB LOCATION 2/ V O/l jeffH Si S ormou.14 NUMBER / STREET ADDRESS / / SECTION OF,TOWN "HOMEOWNER" F-efet- - I(DuT Uhf t- / (- - U�y/7ih Jcc cc>zoo NAME HOME PHONE / WORK PHONE . PRESENT MAILING ADRESS iammi-e z/Y O/d - I, /0c1 SY, YLtrwoJ4 Md. ZIP CODA 7 CITY OR TOWN STATE 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 THE 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) DIE 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 REQUUI• o .NTSS.. HOMEOWNER'S SIGNATURE (/ `tc 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 insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes)q No ❑ If you have checked vis. please indicate the type coverage by checking the appropriate box. A liability Insurance po;i,oy N 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 lass. General Laws, and that my signature cn this permit application waives this requirement. — / . Check one: T ?jy1 , - CwnerX Agent 0 `;nature c, 0,,,,er crOrrner s Agent -- -- --- - -•- - _r . _ . -, . ., .. TOWN OF YARMOUTH BUILDING DEPARTMENT • CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: ' . JOB LOCATION: Zit/ OIcd Malty. Si-. S. Za/atoufin. • NUMBER . �• STREET VILLAGE OWNER OF PROPERTY: --p.6.2.4----p.6.2.4-- D. • 1 I� ,,,...6,„;,.•. ��// CONSTRUCTION SUPERVISOR: R•1c'ka ct 5et,osl<t 007635 72F1'e547 . NAME LICENSE NO. PHONE NO. ADDRESS: /D feel 10 act (,cS• Celu -• ,A(l.to tit A,t LICENSED DESIGNEE: (IF OTHER.THAN SUPERVISOR) NAME LICENSE NO. . 2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: 2.15.1 THE LICENSE HOLDER SHALL BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE IS SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE BUILDING CODE AND THE DRAWINGS AS APPROVED BY THE BUILDING OFFICIAL 2.15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION, ALTERATION, REPAIR, RE1OVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE 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 ANY OTHER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL BE SUBJECT TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. • 2.16. ALL BUILDING PERMIT APPLICATIONS SHALL CONTAIN THE NAME, SIGNATURE AND LICENSE NUMBER OF THE CONSTRUCTION SUPERVISOR WHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECON- STRUCTION, ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.. OF THE CODE AND THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISING SAID PERSONS, THE WORK SHALL I}21EDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPARTMENT. I-HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS FOR LICENSING CC:1- STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERST.•:::: THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. INSURANCE COVERAGE: • • I have a current liability insurance pcficy or its substantial equivalent which meets the requirements of MGLth.152 Yes K . . No ❑ • If you have checked v`s. please ineicae the tyre c average by checking the apercpriate box. i A liability insurance pciicy Other type of :.idemnity 0 Bond 0 OWNER'S INSURANCE WAIVER:1 am awar: that the licensee does rot have the insurance coverage requires `y Chapter 152 to Mas : Ge ral L•ws• Ana that my signature an tn:s perms :sptic:tion waives this requirement ck one: Own Agent 0 Signature at Owner//ar Owners Agent SIGNATURE tit � . BUILDING OFFICIAL APPROVAL: '—',S COMMONWEALTH OF MASSACHUSETTS DEIAR:I.iFNI OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET • James Camooe�: BOSTON, MASSACHUSETTS 02111 ' Go ran:ss,one WORKERS' COMPENSATION INSURANCE AFFIDAVIT • 1, �ia.ric( S eAMM le; (liccnscdpermirtcc) • - with a principal place of business/residence ar, /0 ?bet 44 -Qc�. Ceti-l-r•ea";tie M 19. 024 iz t . (City/Stam/Zip) • do hereby certify, under the pains and penalties of perjury, that: [ ] 1 am an employer providing the following workers' compensation coverage for my employers working on this job. • Insurance Company Policy Number 1 am a sole proprietor and have no one working for me. [ 1 I am a sole proprietor, rener,J contractor .r homeowne (circle one) and have hired the cont cors listed below who have the following workers' compensation in i policies: Name of Contractor . Insurraee Company/Policy Number • Name of Contractor • Insurance,Company/Policy Numb:: • Name of Contractor rInsurance Company/Policy Numb:: �l am a homeowner performing all the work myself. NOTE:.Please be :ware that while homeowners woo employ persons to do maintenance. construction or repair work on a , dweiiin: of not more than titre: units in which the homeowner also resides or on the grounds appurtenant thereto :re not centrally considered to be employers under the Worker' Compensation Act(CL C. 152.sect. 1(5)).application by a boreowoer for a license or permit may evidence the ienl status of an employer under the Workers' Compensation Act. I understand that : copy of this S::tem:en:will be forward:: to the Department of industrial neadent:I Office of insu:--¢ for ccvera:e vcn5ea::on Inc ' . .lure ' S 25A'of MGI.. 152 `en I to the irr.no:i:i:n of criminal penalties . ... ,� secure covers:: as recu:re: under.e^on ._,. con:u:ac of: ,,ac of ut to Y'cr'n 00 azd!or impriso"^--t of un to one ye:: end aspenalties in the form of:5= work Order and a fine of S100.00 a day atin::me. Sic":C — ( Cav of 1 1 9 Suggested Affidavit for Home Improvement Contractor Permit Application For orrice use Only �J NAME I Ct. CITY/TOWN Permit No. Yap lAlo�..Yh Dale AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL a 142A requires that the"reconstruction,alteration,renovation.repair,modernization.conversion,inprovement,removal,demolition. or construction of an addition to any pre-existing owner-occupied budding containing at least one hut not more than four dwelling units....or to structures which are adjacent to such residence or budding"be done by registered contractors,with certain exceptions,along with other requirements. / Type of Work: /, e3r C rre4 ? / ' Est. Cost /Y000fl't — Address of Work 7) C)/r/ �vt SI' S YA,14/4,440411,14/4,44041,14/4,440411.-„,_t f Owner Name: {Tette- rn�cnrw.o� Date of Permit Application:• I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law Job under $1,000 _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. - e Signed under penalties of perjury: I hereby p for a permit as the agent of the owner: • Al 3 .. <>W4 *sr /l7l ik Date .y.tt Contractor Name - •• - Registration No. OR: . Notwithstanding the above notice, I hereby a�a permit as the owner of the above property: • e* Date wncr Name :• n • • 0, 3 41r _S .I At OS a .• •A- rrc L' esJ pJ "pL itMI 1° d• > . >_ ii =• N TcT Zr 1\. , F :3`....-- :: = 3r�I R } D 1. t• o 'n i• >y 0 �♦ P u.^1I'fV ii IciP �pa - r. e :> s eialill r zf 1111 NI 4 ilp s d 1ae< rt 0 x - Nln! r : to c? 5 ati— so- {11: i. n J' : Fni In it pil ,, $$N It sa r-U nJ8 •1 r, 5) I r', 1 •ir zimi, Rat P• ;r <; s i> •,;.' �r i. $• i Fp), (N i u . . r Q ;I? • - - 10 04.2 IP A. F 'i i2 F Y€ r-. c Pc r o Af PP** tg : :'w114 no •Ini_ :It .:. 0 ir- nn .1 .D7 FE VP }p =c ;£ "3^ I. i �� '" Ear A t {[ NIS 0 1 wP E f. Ib• F1 -si 3 Q i �<D�I A Pr I f(p- . s :12;i c - :it: e -<1 ' -1 qlla tr. L) 5i' f € is sFi .; s3 • , f Islet — o: $ ' 111. i I rY i � •µ gni F. . _. LI A k 1 y• 74 rp o33rniii 2�'a not s ^ 5<._— Fe- F Y :3:0 is GCIAn ]p °"> e IN Slijp� 1' 1 • g� R IIF Tr. 14 S �rt 1 T • P Sc it-,‘; _..n r_ F =1 Pd IA 3 Lac . 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