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Home My WebLink AboutBLD-93-598 k ',- ¢ o ' TOWN OF YARMOUTH l� l�� o '�' C OKFCw 819149 le ;,;:: ,MAES Ay, k.. .. Application fora Permit to Build No. L-0-9 r rn Q`►i UPON FINAL APPROVAL v "MAP j-3---- SLOT t/ FEE MUST ACCOMPANY THIS APPLICATION. DATE 0 19 gr The undersigned hereby applies for a permit to build according to the following specif ti ns �i�3 zgsl 1. Name of property owner f� ' isz Tel. 7`1.0 Address ‘ r fnc%?' 2.Name ofArchitect(i ) a Tel. a Name of builder Obi • 4 illi_./ . / Address / - / '/ , , 4. License No. 0° tZOZ Tel. 3'94 i yC 5. Name of Mason Address 6. License No. T: J 7.Construction address - ores-- -y"4rea"'- ,5core 2 , Ce'7 Flood District Ry6 8. Date of subdivision Approval M plain zone C Zone 9. Private dwelling ❑ Estimated Cost P' DO NOT WRITE IN THIS SPACE ,5-113 d scha,e a Dee Type of room No. 10 Multi family ❑D. Joao. $ per 11. Commercial 0 /22 )4(Az i iv xivat Kitchen 12. Other LY r X96 _ (-++-4 Dining Rm. _ 13. No. of stories • 0re2 )Ect Sq GiLiving Rm. t ea-6441a( Bed Rm. 14. Foundation - Full 0 Ha Crawl ❑ Slab ❑ $G Citi irk i a i 15. Materials - Wood TY-Cement 0 Other 0 .>C- Dec19.0,222 16.Type of heat - Oil 0 Gas 0 Electric 0 Other 0 5/f porch( -/J_ 17. Garage - 1 ❑ 2 ❑ - a as a-Family Rm. ;� Sun room 18. Swimming pool -Size3 a Garage 19. Storage shed - Size 9� 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 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 Signaturee _.ef_.. /� �/� ' PLANNING BOARD Address S C.c . .reZ`L/ Date I✓- i•-rl M•4 �t I , APPLICANT: /' /'tiwL.2.Q BUILDING PERMIT i"': ADDRESS: r ac./..4petn TELE. NO. : -AW 25-9/ DATE FILED: t/SA3 BLDG. SITE LOCATION: d a N S MAP/I: SJ LOU: - 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 COTPfERCIAL 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: REVIEWED BY: rm AA 7( 1. WATER DEPARTMENT /n'.,a J �' ( i /i+ \ DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT DATE: 15)/ 5113 N/A: U RIAL 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: ,, .!. __ S^* 7 A [ JT) ',',P ) I'nA) r-IL CP-P firitne • • ljL.b�° — mA/ST i97))D -ye /o t¢t—zti 7i.1-e _o J eaiLes d=0 "? • BLM/89 92(C*7 Pas • TOWN OF YAMOUTH • BUILDING DEPARTMENT HOMEOWNER LICENSE E 1)11.1110N PLEASE PRINT: DATE 043 JOB LOCATION .5" Coo s 2 ( gft NUMBER ` STREET ADDRESS SECTION ;TOWN TOWN "HOMEOWNER" 4.71 ® G<�.�i��ez T/, _.le((((((///z c Za NAME HOME PHONE WORK PHONE Z PRESENT MAILING ADRESS • ,� G �`e ,,��iec✓ L,I y�_ s NTN G /L.�. JO 3-62/ 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/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 PERFO ai 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 PROCED ' S AND REQUIREMENTS. HOMEOWNER'SGNA - e �` 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 aY �urrent liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. es If you have checcked,ts, please 'indicate the type coverage by checking the appropriate box. A liability Insurance pokey ,Other type of indemnity ❑ Bond 0 • OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: • Owner ❑ Agent 0 . Signature of Owner or Owners Agent __ _ — _ • C'' �y COMMONWEALTH OF MASSACHUSETTS P' 'o �.--` l' a. DEPARTMENT OF INDUSTRIAL ACCIDENTS __ S' 600 WASHINGTON STREET James Campoeu BOSTON, MASSACHUSETTS 02111 Gommrsseoner • WORKERS' COMPENSATION INSURANCE AFFIDAVIT • 1• aS`ter —moi, t,an_ecC,- (licensee/permittee) • with a principal placeeo/of an kesidence // (City/Sure/Zip) • do hereby certify, under the pains and penalties of perjury, that: H 1 am an employer providing the following workers' compensation coverage for my employees working on this job. @@ -- • - ... • p Insurance Corhpany Policy Number s� I am a sole proprietor and have no one working for me. XI am a sole proprietor, general contract() dt 'role one)and have hired the contractors listed below who have the following workers' compensation ins ce policies: ,CLG4 �• ami, iL Name of ContractorInsurance Company/Policy Number.. . Name of Contractor • Insurance Company/Policy Number • - .. - • Name of Contractor Insurance Company/Policy Number _ I 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(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 • 1 understand that a copy of this statement will be forwarded to the Department of Industrial Aeddenu'Office of Insurance 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; day against me. an • • ,e Signed t ' —. • - _ !'day of , 19 Lice::sceiPermi^et: Licensor/Permit-tor • • Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only NAME OF CITY/ OWN Permit No. Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL n 142A requires that the"reconstruction,alteration,renovation.repair.modernization.conversion,inprovement,removal.demolition. orconstrvction of an additinn to any pre-existing owner-occupied building containing at least one hut not more than.fourdwellino units....or • to structures which are adjacent to such residence or building"be done W registered contractors,with certain exceptions,along with other requirements. n Type of Work: 3/ 7 SCR6 "9? [ eco Est. Cost le Zoo. Address of Work - 1/45- S�/ 1 �s`-7Lj �/� I *�V Owner Name: c fie.2, peLetze Date of Permit Application: a1I �J-3 I hereby certify that: // Registration is not required for the following reason(s): Work excluded by law - Job under 51,000 1..4—u-ilding not owner-occupied .L.Awner 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 permi'�gent the owner: �" 3 at Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name • FOR LOT n 3 `r Indicate locatcn of garage or accessory building • Additions with dashed lines Sewerage disposal (cesspool) ED Well p 1 (lot •ft. rear) 4buttor's I d Abuttor's Vame I Name Lot # II ��V I Lot # • 7� \ s ° REAR YARD :f this isa ' If this is orner lot, .... I.`5. ...ft. corne_� lc ..,rite in name N 1 write in �� )f street. '� _I name of f i I i. p other U 0 i I u street. ,. C I .. J . al SIDE YARD SIDE Y..1r 0 ,zo FT. HOUSE p -——`/‘ CJ - 3. - , . . I ti IN Ne I \ SET BACK a .. .Vo 94. /.ft. c ....,.s... .... 1 c... . .fr (1,. 2D0 f` frontage) \ / ecc4gssit 47% \ - •/ • - (NAME OF STREET) \ / / \ OA/ eteaci-c—__ / \