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Home My WebLink AboutBLD-93-601 �1 YAe 1p- 6r2g��GIq3ke- TOWN OF YARMOUTH 4.x �H ,S. Application for a Permit to Build No. 60 I- UPON FINAL APPROVAL gr4 2---q3 MAP 3-9 LOT 7-1-- FEE -2FEE MUST ACCOMPANY THIS APPLICATION. DATE 6//C 19 93 The undersigned hereby applies for a permit to build €0a/93 according to the following specifications 1. Name of property owner Poo-4ni 1 Tel to .2—7/ Address � 2.Name of Architect(if any) i=71�:. 't '. '—/` *-c tt17' -14?-2.--17 troy 0 a Name of builder .... - .rt 4 'ddress 774 w g�- 4. License No.OO,S- a/As Tel. 5.4 2 ,) 7/ CIC£L� 4k49.. of ,Q, 5. Name of Masonv4-nn..i- Address ! °1/4 l ulat$tace,-`icf..a6 6. License No. 0 3 y ;7 96 Tel. ,fb A `/41 7 ; 715- 7. 15•7. Construction address 57rLiMrtA - :s" o,/ Pd�� au„,-.0____.4 Flood d" CDistrict 6 8. Date of subdivision Approval plain zone Zone f2 ^ q 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE Co/t/osineav4- Type of room No. 10. Multi family 0 d-b 06 6 grv� Cokc-rr4gcaa- / 11. Commercial g - ' Kitchen 12. Other 0 74(7 S/= Dining Rm. 13. No. of stories 3D Living Rm. 5,41, /0 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 ^//G ' Closed porch 17. Garage — 1 0 2 0 ! ' Family Rm. Sun room 18. Swimming pool - Size i 4, 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 P 0/n No. of feet side 37-/. 4" " No. of feet rear 2-" IC) 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 Signature 9 1tt PLANNING BOARD Address 7 7 c toosaP`-'^.yea" . Sam Date Cs-cZ�,vc__ 1cvc. c -_. 0 2 a s / APPLICANT:r pp e' Lel • BUILDING PERMIT i`: ADDRESS:?7g '1QJo•c►I nv‘Sf 44„rtow � TELE> NO. :co gj,g; gSsb DATE FILED: BLDG. SITE LOCATION:Q Phi, 0,1.AL--1/4-4 MAP/1: • LOTH: 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 COI21ERCIAL 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: - 1. WATER DEPARTMENT . --. `• ' - -e.-O >',4 DATE: 2 - `-'1 j N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: B. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT )IU41M fri , t✓j /1/ DATE: ,Q„��y' 3 N/A: // INDUSTRIAL /OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: /� DATE: AUG en 1993 N/A: II- 5. PLUMBING INSPECTORv: . / / f,�, , � DATE: C=- -9 - c,• N/A: 7. FIRE DEPARTMENT: c ASLDATE: ,F.. 11--5'3 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: .C!'�/Jl�� BLM/89 • BUILDING DEPARTMENT • . ' CONSTRUCTION SUPERVISOR FORM LEASE PRINT: .. (' .. . . . ` ' ' • OB LOCATION: 011.Re-s•I.q U R/."'' Xw iYYt4't U NUMBER (� • ST ET (� VILLAGE WNER OF PROPERTY: • re-Cil-14 e,-? . ' G CONSTRUCTION SUPERVISOR: �'h-�n 4- �i.t,Cfil ods.. ./ g • ' 5c5 g2-2,g2-2, a 1/ e (/ NAME . . LICENSE NO. PHONE NO. . • ADDRESSi d-'t o { -1�,trc.,. c1�+.v 121-d-4-&. 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, RE:OVAL 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. • "r 1 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:M.EDIATELY 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 CCI 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 pcl!cy or its substantial equivalent which meets the requirements of MGL'th.152 Yes ❑ ' . No ❑ • If you have checked v_s, please incicnte the type cverage by checking the ap:rc:riate bcx. ' 5 A liability insurance ;tic/ 0 Other type of :.idemnity 0 dcnd 0 ' OWNER'S INSURANCE WAIVER: I am aware that the licensee dces ret have the insurance coverage requires :y Ch:pter 152 of the Mass. General Laws. anc that my signature cn tn:s permit c:p;ica:icn waives this requirement Check one: Owner Agent 0 Slgneture at Owner cr OH•neerr a Agent SIGNATURE:J tit t- ) LCc.G1/ BUILDING OFFICIAL APPROVAL: TOWN OF YARMOUTH BOARD OF HEALTH ADVISORY LETTER #25-A TO: COMMERCIAL/RESIDENTIAL BUILDERS DISPOSAL WORKS INSTALLERS • FROM: BRUCE MURPHY, HEALTH AGENT FORREST E. WHITE, BUILDING INSPECTOR DATE: MARCH 5, 1987 REF: DISPOSAL OF STUMPS & BRUSH FROM BUILDING SITES NOTE: THIS ADVISORY LETTER SUPERSEDES ADVISORY LETTER #25, DATED AUGUST 23, 1985 ON NOVEMBER 18, 1986 THE BOARD OF SELECTMEN VOTED TO PROHIBIT ALL STUMPS AND BRUSHES LOADED BY MACHINE FROM BEING PUT INTO THE LANDFILL, EFFECTIVE JANUARY 1, 1987 PLEASE BE ADVISED THAT, AS OF THIS DATE, WHEN APPLYING FOR A BUILDING PERMIT THE APPLICANT MUST PRESENT AN AUTHORIZED STUMP/BRUSH DISPOSAL RECEIPT INDICATING WHEN . ALL STUMPS AND BRUSH, CLEARED FROM THE LOT(S) , HAVE BEEN DISPOSED OF, AS IT IS NOT REQUIRED THAT ALL SUCH MATERIALS MUST BE DISPOSED OF IN ACCORDANCE TO REQUIREMENTS OF THE DEPARTMENT OF ENVIRONMENTAL QUALITY ENGINEERING (DEqE) , UNDER THE MASSACHUSETTS GENERAL LAWS: CHAPTER 111 - SECTION 150A. WITH REGARD TO DISPOSAL SITES, ALL SIGNED DISPOSAL RECEIPTS WILL BE FORWARDED TO THE , HEALTH AGENTS OF EACH RESPECTIVE TOWN, AFTER THE ISSUANCE OF THE BUILDING PERMIT. AFTER ISSUANCE OF A FOUNDATION PERMIT, AND PRIOR TO OBTAINING A BUILDING PERMIT, THE SIGNED STUMP/BRUSH DISPOSAL RECEIPT, WHICH INDICATES THE SITE OF DISPOSAL, MUST BE , SUBMITTED TO THE BUILDING INSPECTOR. IF THE APPLICANT DOES NOT HAVE A SIGNED RECEIPT INDICATING LOCATION OF DISPOSAL, NO BUILDING PERMIT WILL BE ISSUED. ANY QUESTIONS, RELATIVE TO THE AFOREMENTIONED, MAY BE DIRECTED TO EITHER THE BUILDING INSPECTOR OR THE HEALTH AGENT. MAP: PARCEL: LOADS: DISPOSAL DATE(S) : CONSTRUCTION SITE: ., PRIVATE DWELLING : MULTI-FAMILY: CO:DIERCIAL: OTHER: OWNER OF PROPERTY: 1-et-t-4-%-11 4 ? ' i9/-14- /TELE:37 $ 01;1,3 t NAME OF CONTRACTOR �� 1�.� ( jr CLEARING SITE: .. � i r-{ .. ' T 1Pa885-8O DISPOSAL SITE FO' TUMPS BRUSH: . = 29Me rfe' - Ara " A) f •-d 4./ E. I --�� SIGNATURE OF GATE AT ENDANT AT DISPOSAL SITE DATE: �� _ / ' I - 2-1--Tri. --Z-F4:.5117: `== � COMMONWEALTH OF MASSACHUSETTS �, R T DEPAAIET�T OF INDUSTRIAL ACCIDENTS • �",. - 600 WASHINGTON STREET James J Campoel: BOSTON, MASSACHUSETTS 02111 • Comm:ssrone• - - WORKERS' COMPENSATION INSURANCE AFFIDAVIT • 1 I____ , C - (license�e) • with a principal place of business/residence at•. • • 7 7 p rid 1-( CcnS 4 14 41-'¢ 2 ( . • (Cry/Surdzp) do hereby certify, under the pains and penalties of perjury, that: [ 3 1 am an employer providing the following workers' compensation coverage for my employees working on this job. • Insurance Company Policy Number ( ) 1 am a sole proprietor and have no one working for me. ( ) I am a sole propricror, general contractor or homeowner (circle one) and have hired the cen:actors listed below who have the following workers' compensation insuranc policies: 46G• Q C (� L�Lt7cf i ...locapteei Cao . Name or Contractor Insurance Company/Policy umber • Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Numb:: 0 1 am a homeowner performing all the work myself. • NOTE.Please be aware that while homeowners who em:ioy persons to do maintenance.coostrueriot or repair work on a dwciiinc of Act more than1th:ee units in which the homeowner also resides or on the grounds apcur.enant 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 kcal status of an employer under the Workers' Compensation Act I understand that : copy of this srtcmcnt will be forwarded ro the Department of Industrial Acddents' Once oiinsu..nc for coverage cr:ac:;on and ;ha: failure to secure cave%e as required under Scion 25A'of NIGI. 152 an lead to the in positi:n of criminal per.alties ccnsts:nc of: . • SI . - imprisonment• .. tine of upto 500.00 ana'o:smpruonm nt or up to one yea and evu penaltiesta the form o. ::::: work Order and a fine of SI 00.00 a day acains:me. Ste:'_.. :his ' PI da v of `c'" 19 9