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HomeMy WebLinkAboutBLD-93-603 Y r 09/93 $s r o TOWN OF YARMOUTH © Kr✓ glib/13 :; :-.:3, ATTACM[ 5 � � ..Jit Application for a Permit to Bu'1� dy, No. 3 UPON FINAL APPROVAL g,�a�3 MAP � � 6 LOT /4' I FEE MUST ACCOMPANY THIS APPLICATION. DATE 7/9 19 73 The undersigned hereby applies for a permit to build ////9.� according to the following specifications 1. Name of property owner 7 co- r O t Te1.37e a.23/ Address 2.Name of Architect(if any) "10 1.4 *- X n4 tfrte- Te1Z-17i ciaa a Name of builder 7tiy Address 770' fda4 �tr' L,a-scte-r.L, Mot,. o.g. o.:2./ 4. License No.COCC A f 8 Tel. S .,Q V.-- 01 7 / i3 5. Name of Mason Sri Za Address I Van IicaM - 714-4..,. 6. License No. 0 7 Ll 3 9' 0 Tel.sCo 9 94'7 (0 7 75- 7. 37. Construction address �- i 9 off Ca44-4-0-01--a- n �-- Flood G District in 8. Date of subdivision Approval plain zone Zone -LIo 9. Private dwelling 0 Estimated Cost, DO NOT WRITE IN THIS SPACE 10. Multi family 0 �v o o CozA2osia7Na—L Type of room No. 6- epithet d / 11. Commercial f . -�a Kitchen 12. Other 0 Dining Rm. 13. No. of stories I 7 i{7 SF Living Rm. 3o Bed Rm. 14. Foundation - Full 0 Half • Crawl ❑ Slab D 2.-62#, i o Bath 15. Materials - Wood 0 Cement 0 Other 0 Deck 16. Type of heat - Oil 0 Gas 0 Electric 0 Other 0 �/ Family Rm. 17. Garage - 1 ❑ 2 ❑ ff Closed porch Sun doom 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 y No. of feet rear - ��No.of feet deep 22. Size of building. No.of feet front c2 0 • b No. of feet side 3 7- `f No. of feet rear 4 610 if 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 / PLANNING BOARD Address 7 cfre- Date L;otiCeri.- -e APPL"ICANT:rm.( lO f / '� BUILDING PERMIT 4DRESS:�7(p V Gk�( p �.�yWct{� ?1?_�+4r „, )Aa.4*TELE. NO. :`{ ] 8299S� DATE FILED: BLDG. SITE LOCATION:, Jq off(3 M1. yAt ted MAP/I: • LOT/I: 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 COPL`IERCIAL 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 , i , .. . 1-, Y fp,.I)IIDATE: a-9-93 N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: B. CONSERVATION: DATE: N/A: HEALTH ALTH DEPARTMENT 74,404i)4' , 6fr (/1i DATE: S>-'70 . 5 '3 N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: �7":„.>"2- , , DATE: AUG - 9 1993 N/A: G. PLUMBING INSPECTOR: /c /i r- ,,I -t / / 'P A { 4/ DATE: .- 4 7S N/A: 7. FIRE DEPARTMENT: 7 Lr.� 1 J . DATE: ��//y3 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 I.SUANCE •F , 1E BU .e NG PERMIT. -_-_ COMMENTS:. _1wns- S .„..L_ ------ c.:.�:'tel %GiTC'- - • ytD -Ave-. s)%f- - h..) /cuvt✓ 13 LM/89 TOWN OF YARMOUTH . - • • BUILDING DEPARTMENT • . • CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: p /p n�. QQ . I� • A :� JOB LOCATION: 5- Ca� 1• ! t .� 4`"d/✓?l.ct-•t-vV(N • NUMBER •eyrie pp STREET VILLAGE • OWNER OF PROPERTY: rbW'Yl, C J .�aJvfl1-0-44 L4.1 . . . . CONSTRUCTION SUPERVISOR: y &bog 4111 p o� oZ-1 1 - NAME LICENSE NO. PHONE NO. . ADDRESS: j t ;L TRwV+ as�% f.G.d.d : 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, 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 IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPART`ENT. . 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 policy or is substantial equivalent which meets the requires encs of MGCth.152 Yes J . No ❑ • • It you have checked v`s. ,^.:ease incic to the type c average by checking the ap:rcpriate box. • l A liability insurance pc:icy 0 Other type of ..idemnity 0 Bond 0 • OWNER'S INSURANCEE WAIVER: I am aware that the ecensee does rot have the insurance coverage requires :y C`apter152 of the !Hass: General ant tnat my signature on th:s perm¢ c:pticaticn waives this requirenien: / ` Check one: • ami I Z _sag; Ownerj-., Agent 0 Sign tact Owner or Owners agent TOWN OF YARMOUTH BOARD OF HEALTH ADVISORY LETTER 1125-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: 7 - '--if • O' TELE:378 .2A 3 , NAME OF CONTRACTOR CLEARING SITE: Affialiffe TELE: DISPOSAL SITE FOR O(RR TTUITS BRUSSHC/�t_�:. a) .�M t :. �� - . • SIGNATURE OF GATE ATTENDANT AT DISPOSAL SITE DATE: g/lv/yam' = 744"• --* ` `—�- COMMONWEALTH OF MASSACHUSETTS 'C^' =t5- El DEPA1r:hfrl' OF INDUSTRIAL ACCIDENTS V>. . - - - —' 600 WASHINGTON STREET James camooee BOSTON, MASSACHUSETTS 02111 • romn.55tone• - - WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • (licensee/perm i n te) • with a principal place of business/residence at: • 1-----774 4,ca., . er CG-t. az., rit'i eta D.2.'6., 2( . (City/State/Zip) \---- - do hereby certify, under the pains and penalties of perjury, that: • [ ) I am an employer providing the follow' g workers' compensation coverage for my employees working on this job. � i Insurance Company Policy Number [ ) I am a sole proprietor and have no one working for me. [ ) I am a sole proprietor, zone contractor .r homeowner (circle one) and have hired the contractors listed below who have the following workers' oma- . non insurance policies: Name of C rracorM . Insurance Company/Policy/Number ,,. - Name of-Contractor` Insurance Company/Policy Numb:: Name of Contractor Insurance Company/Policy Numb:: 0 I am a homeowner performing all the work myself. NOTE:.Please be aware that while homeowners who erploy persons to do maintenance. constraaion or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appur.rnaat thereto are not generally considered to be employers under the Workers' Compensation Act(GL C 152,sect. 1(5)). application by a borcowper fora license or permit may evidence the legal status of ao employer under the Workers' Compensation Act. 1 under::and that : ropy of this statement will lx forwarded to the Depart:nen..t of Industrial Acddens'Oflice ofirsur.nd for coverage vcrifcaaon and that failure to ir_ure cove.--ze as recuired under Ser on 25A'of MM. 152 an lead to the in no:kian of c-'—final pen. ues ccnsis:ng of: tine of up to S1500.00 and/or imprisonment of up to one year and dvii penai :s is the form of:St::Work Order andel fine of 5100.00 a day against me. /% ` 4 �ic^.._ anis ! da c , 19 _ c:r.:::i•_,....-_. '—:__-:o.;:•_...,,.._