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HomeMy WebLinkAboutBLD-93-602 a T O� F/9�931 itt,k ,0 it, 0 TOWN OF YARMOUTH °Ka/ clot?j,.__ ,0 tiim; _ t 60 d—) ID,,4'^...... •id.; Application for a Permit to Build No. UPON FINAL APPROVAL 5 1 �--1 MAP /49 3 LOT lea FEE MUST ACCOMPANY THIS APPLICATION. DATE 7/9 19 93 The undersigned hereby applies for a permit to build ed//93 according to the following specifications 1. Name of property owner /0,0A/ 6 /– Me/n"o'✓/ Tel. Pi�-- .41 Address 2.NameofArchitect(ifany) 1i /07////N -I--/46149/3t5 /A/ ! 'Tel. f7S060 a Name of builder 1'/e Alt/CK .ddress776/einhfrG/e�J $1 4. License No. 06-CA/f Tel. ��.Z _0,7/ ��'Nm^�•��• b�z� 5. Name of Mason ay. 7*11-3O '/ Address /J Wt9GL S% WN))tgi?o n /49 , 6. License No. ©!t/? 76 Tel. S ' 9i/7-- C7'C 7. Construction address /76n-' ST,1,a.J 4/7/laN i �/ � Flood / Dist ict 8. Date of subdivision Approval plain zone e- Zone s-- -7 0 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE 10. Multi family 0 j`Q p�� Cot�65/en k, Type of room No. J saw _ O,41rgoz sac_ 1 11. Commercial* - Kitchen 12. Other ❑ 7p cc Dining Rm. 13. No. of stories "•'.3 a. Living Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bad Rm. Bath ' 15. Materials = Wood 0 Cement 0 Other 0 / Deck 16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 - Pia. Closed porch 17.Garage — 1 ❑ 2 ❑ !!! Family Rm. • 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 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. p LOT RELEASED BY e/Signature .w// -cr '11"--e-A-1PLANNING BOARD Addre s 776: 2(/ . ° . - Date - 7140 r l 1 ' APPLICANT: / f ie/ 4-• BUILDING PERMIT i`: ADDRESS: `-7 Cs 'Waal..., 4.fre Co4•leo4t r1' LE: NO. : $e2 f3 SS gADATE FILED: BLDG. SITE LOCATION:1 MAP/r: • 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 COPPIERCIAL 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. IIEALTH•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"),, -S "DATE C.; 9 -q 3 N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: 1 DATE: N/A: 4. HEALTH DEPARTMENT' DMA IU. 4444/ni//1/ DATE: ) Id - N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: ,...e�Z1 /, DATE: Ai . 9 o N/A: G. PLUMBING INSPECTOR:: / / i(fl DATE: N/A: 7. FIRE DEPARTMENT: " Lr6 DATE: _3/4 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 PR'"R`TO I S ANCE CLF/IE BUILDING PERMIT. A // COMMENTS: > 1, i r' . < ( W - A? per/ SI aetitu G•PjrrrJ I3LM/89 T • BUILDING DEPARTMENT . CONSTRUCTION SUPERVISOR FORM LEASE PRINT: rr�� � � � � c. f • . • JOB LOCATION: ►( u„ • t14 S • . •• • , . NUMBER TREET VILLAGE • OWNER OF PROPERTY: . TtTr .0.44. 1 G 4� �!Y -1' • • • CONSTRUCTION SUPERVISOR: O a e / t� ' . 66D2 .2 7 / 8 • . JLICENSE NO. PHONE NO. : L to r•o.�, /.�1 741;i4;1-,.-as-i^..- ADDRESS '. 2k.2_4_44__ 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, 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., .A$ 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 DE::OLITION AS REGULATED BY SECTION 109.1.1 OF THE CODE AND THESE RULES AND REGULATIONS. IN THE. EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISING SAID PERSONS, THE WORK SHALL ILMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPARDCNT. I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR LICENSING 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 policy or its substantial equivalent which meets the requirements of MGLth.152 Yes J . No ❑ • If you have checked v`s. please incicate the type cverage by checking the ap.rcpriate box. A liability insurance pciicy 0 O:her type of :.idemnity 0 Bond 0 • O•NNER'S INSURANCE WAIVER: I am aware that the licensee does rot have the insurance cover;: requires =y Chapter 152 of the Mass. Genera: Laws. ane mat my signature cn tn:s permit :cp:lc:ion waives this requirement. Check or,e: • Owner:_ Agent 0 Sign MUM of Owner cr�Owwnneer s Agent ' RIIE: ""cr""' • SZGNAT r 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: COMMERCIAL: OTHER: OWNER OF PROPERTY: Ute/ ei 'yi9'��eivi71 TELE: 3.p �05t) NAME OF CONTRACTOR --,4‘ ��a _- b.-CLEARING SITE: ` . 1c. "' TELE:, DISPOSAL SITE FONMSTU SPS RUSH: SJ Orne 4131092AireneAf 2511,97 SIGNATURE OF GATE ATTENDANT AT DISPOSAL SITE DATE: 44,44zr • : = dl = COMMONWEALTH OF MASSACHUSETTS .azD• EPARTMENT x MEIrT OF INDUSTRIAL ACCIDENTS • .600 WASHINGTON STREET James J Camaoee BOSTON, MASSACHUSETTS 02111 • rommastoner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • (licensee/per-mince) • with a principal place ofbusiness/residence ar. • • • 7 74 -i-tt-a-a 02- • (City/State/Zip) do hereby certify, under the pains and penalties of perjury, that: • ( ) I am an employer providing the following workers' compensation coverage for my employees working on this job. • • Insurance Company Policy Number [ ) I am a sok proprietor and have no one working for me. ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the cent actors listed below who have the following workers' compensation insurance policies: a 6 G Z i EEY74 c A A revert 4 Co- La— O Name of ontractor • Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Numb:: Name of Contractor Insurance Company/Policy Numb:: 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 centrally considered to be employers under the Workers' Compeasation Act(GL C. 152.sect. 1(5))0 application by a homeowner for a license or permit may evidence the ictal status of an employer under the Workers' Compensation Act 1 undo.^.:and that a cony of this statement will be forwarded to the Department 0/industrial Acddens' Office ofinsu.nen for coverage verif:a:mn and that failure to secure cove.-e as recurred under Section 25A'of MGL 152 ca lead to c:.: imoosi;icn et criminal penalties consisting or': fine of up to 51500.00 an&or imprisonment of up to one year and dvii penalties in ti:: form of:Ste:Work Ord:: 'and a fine of 5100.00 a day arains:me. 9d moi'' � $ic ,.its /r�p/ _ " dayof L�` ! 19 9_3 (1