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4.4:, .- too TOWN OF YARMOUTH gel°193
'.,• MATTA,�E _- �'- for a Permit to Build � Na �97
�,�ero..,,o��i 'Application
-se" 1 ' 63
UPON ANAL APPROVAL ' gJ�� '�MAP a7 1_9; ?`Z
FEE MUST ACCOMPANY THISAPPLICATION. A DATE 0 19q .3
The undersigned hereby applies for a permit to build g,1/0/9-2
according to the following specifications ' • `
Name of propertyowner - '��-2ACee" Tel.
vAddress 67r ,eT of Cu. yA,eµ asTli
2.Name of Architect(if any) Tel.
Name of builder en C#992''4 `' II r s°'YS Address as Ot op/w 4 f- ,/ *'A
�License No./ c 3 7' Y Tel. c753- - -c-c6 9 o<[ Ns
5. Name of Mason Address
6. License No. Tel. /
f Construction address 1 / F el. or \4 ynem v v S
Flood Zone District G ��
8. Date of subdivision Approval plain zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
Type of room No.
10. Multi family 0 LZ/f, Ca
leetiias /
11. Commercial 0 car etc p God./ 1-c S , Kitch n
12. Other ❑ o� Dining Rm.
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 Deck
16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch
Family Rm.
17. Garage — 1 0 2 ❑ Sun room
18. Swimming pool - Size Garage
19. Storage shed — Size Shed
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
2a 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 re � `" " c---c-0—e°
BOARD" °" -La- `T ddress- 7 de---44 • ---/
Date
TOWN OF ,YARMOUTH
• BUILDING DEPARTMENT • . . . - -
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
JOB LOCATION: lo2 7' .el" �c?f (Ad yf9c. d 7 . .
OWNER OF PROPERTY NUMBER."
• , .• 1C// r• te• ' STREET /. VILLAGE
CONSTRUCTION SUPERVISOR: I\ t �+ ' , /3 t(� (fz •n •69 d , l • O /0' 7 6 `l. - . •/,_F
NAME . LICENSE NO. • PHONE NO. .
•
: j • .
ADDRESS: '7 a (j4f.r -iOnt .-Ted; , • . ICcAfTpit0 (4../// . _ r
S
LICENSED DESIGNEE: '
(IF OTHER.THAN SUPERVISOR) NAME LICENSE N0.
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, REMOVAL 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 D;;''IOLITION 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} SEDIATELY 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 :ICENSING CC:I-
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTAN:
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
OFFICIAL. •
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGLth.152
Yes ❑ . No ❑ ••
If you have checked yes, please indicate the type cwerage by checking the appropriate box. ,
.
A liability insurance pc:icy 0 Other type of :.idemnity 0 ' ' ' Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the ncensee dcei not have the insurance coverage required t:y
Chapter 152 of the Mass: General Laws, ana that my signature on this permit ccplication waives this requirement
Check one: •
• ' Owner° Agent 0
Signature of Owner or Owner s Agent •
cIGNATURE:' !r7 BUILDING OFFICIAL APPROVAL: w