HomeMy WebLinkAboutBLD-93-604 .. $0,742g/9/93
',“ Tr o TOWN OF YARMOUTH otcreL, Vohs
ClMATTAGIE 5 r 6°J K
,,te« ,00, : Application for a Permit to Build No.
$ I2-13
UPON FINAL APPROVAL MAP 4 t LOT R I
FEE MUST ACCOMPANY THIS APPLICATION. DATE7'9 19 93
The undersigned hereby applies for a permit to build 6.7g/93
according to the following specifications.
1. Name of property owner '7 -ccrl 7P ,, TeLY9 8 22:3(
Address
017
2.Name of Architect(if any) 4C/2-.4- -/- /` 0-4te-k as Telt; 7-.fd co
3. Name of builder r ddress 71 C C✓aAc� c . sr
(
4. License No. oa.7`.a / Tel. 922 a7i `a `' a209
5. Name of Mason ti. Za4.+4-1,L - Address be "W St 7.0- 4-net.
6. License No. n 7'-( :3 9 0 Tel f 9y 7 G 7 75 ,/r���3
7. Construction address � /X : 46R sa f�N ►Gw I y
Flood "District
8. Date of subdivision Approval plain zone Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
Q ttocV o,v Cea r'i Type of room No.
10. Multi family 0 ,1 e2 a o d Bac-- t inen. ae-W-, /
11. Commercial 10. Kitchen
12. Other 0 7� SF Dining Rm.
• l.-'3-° - Living Am.
13. No. of stories „. ) a`r P.c/,/° 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
17. Garage - 1 0 2 0 Ne Family Rm.
Sun room
18. Swimming pool - Size Garage
19. Storage shed - Size Shed
20. Stove I Wood 0 Coal 0 ' ' Alterations '
21. Size of lot: No. of feet front No. of feet rearNo.of feet deep
22. Size of building. No. of feet front <20 's No. of feet side 3 7 9 I No. of feet rear ao � a
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 1- 'C"""/
PLANNING BOARD Address '
et/t1.4.-.44-441C.-..-- .
Date Co" 'E.' 09, 02 /
APPLcANT: f t ( lCer' BUILDING PERMIT P:
ADDRESS: 7 7 Sir " _/_rx, s TELE. NO. : DATE FILED:
RSIE I'uNQ R 1.5
BLDG. SITE LOCATION:SL 17 (, "t/ * MAP If: 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 COMMERCIAL 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 LOTS) 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: C
1. WATER DEPARTMENT 1 / , t� -r- Q '2_ 1. ./7„..jn{ DATE: s.-9's .5 N/A:
2. ENGINEERING DEPARTMENT: I DATE: N/A:
3. CONSERVATION: DATE: N/A:
4. HEALTH DEPARTMENT )j� j/l4 , 14/441(A., DATE: ?../(t) .- 7,3 N/A:
INDUSTRIAL AN OR COMMERCIAL PERMITS
5. WIRING INSPECTOR: ���7��15.- DATE: AUG - 9 1993 N/A:
6. PLUMBING INSPECTOR: . .. / i A r ._..,eA DATE: pr � qa. N/A:
7. FIRE DEPARTMENT: 717- 4i DATE: cr1/2, y.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 PRIG' TO ISSUAN E OF BUILDING
PERMIT. if, a
COMMENTS: __worm,. p ,,_ G•
1.4409 - 43 e- .svT'er/pu DPW L cJ
HLM/89
1 • BUILDING DEPARTMENT ••
' CONSTRUCTION SUPERVISOR-FORM
LEASE PRINT: rp
OB LOCATION: sZ 17 ' 0 , C katC'�7.�•LcA,
' • NUMBER . ST ET VILLAGE ••
WNER OF PROPERTY: ' re—tArw ed • V
CONSTRUCTION SUPERVISOR: �' 0 0 S. ( 8 e 3.02. 271 a
NAME 1 LICENSE NO. PHONE NO.
ADDRESS: (rev .
LICENSED DESIGNEE:
(IF OTHER,THAN SUPERVISOR) NAMELICENSE 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 3E 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 DEPARTMENT.
I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR LICENSING 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 MGLvth.152
Yes 0 . No 0
If you have checked v_s. p:ease incicate the ype c average by checking the ap:rcpriate box. .
5
A liability insurance pc:icy 0 Other type of :.idemnity 0 Bond 0 •
OWNER'S INSURANCE WAIVER: 1 am aware that the i:censee does rot have the insurance coverage require: _y
C`apter 152 of the LAass. General L'ws. anc that my signature on t`:s permit ::p:ic:tion waves this requiremer..
Y Check one:
d- Owner:/ Agent 0
SIgr,atu or Caner cr Owners:.gent ,
-GNATURE: 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 SIGNEED 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:LMERCIAL: OTHER:
•
OWNER OF PROPERTY: Z-tt t t TELE:IfS ,2�, i /
NAME OF CONTRACTOR "�'s:-•�.,
CLEARING SITE: $� BELE: "
DISPOSAL SITE FOR ' UNP: BRUSH: ear % A-,L 4z3ec407200 , "
SIGNATURE OF GATE ATTENDANT AT DI POSAL SITE DATE: /14/
r � _
COMMONWEALTH,. _ = COMMOWEALTH OF MASSACHUSETTS
t^• • c' DEPARTMENT OF INDUSTRIAL ACCIDENTS
•
� 600 WASHINGTON STREET
',lames J Campoeu BOSTON, MASSACHUSETTS 02111 •
romp:ss,onet • . —
WORKERS' COMPENSATION INSURANCE AFFIDAVIT •
I, rte,, .- &.
(liccnscc/per ince))
• with a principal place of business/residence an •
•
72 Q gd` C - ` +orb.z / . .
(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 sole proprietor and have no one working for me.
[ ) I am a sole proprietor• general contractor or homeowner (circle one) and have hired the contractors listed below
who have the following workers' compensation insurance politic: esG L 22 9 $ tc-,{ 7 6 C 71 A-
.
9 ny
Name f Contractor Insurance Company/Policy umbo: ,•. ..
Name of Contractor Insurance Company/Policy Number • • •
Name of Contractor Insurance Company/Policy Numb::
0 I am a homeowner pc forming all the work myself.
NOTE.:.Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a
dwciiin: of not more tha: three units in which the homeowner also resides or on the grounds appurtnant thereto are not generally
considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)). application by a homeowner fora license
or permit may evidence the Ictal status of an employer under the Workers' Compensation Act.
I understand that a copy of this statement will be forwarded to the Department of Industrial Aeddens' O lice of Insumnm. for coverage
vrifca::on and that failure to ie:ure cove.-4e as required under Sedon 25A'of MGL 15: an lead to trate imposition of criminal penalties
censis:ng of: tine of up to 51500.00 and!or imprisonment of up to one yea:and dvii penalties in t:.: form of a St:: work Order 'and 2
fine 0E5100.00 a day again,:me. r/
$iCn .,. this r""�' day of 19 93