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Home My WebLink AboutBLD-93-606 19199 4 err t, o TOWN OF YARMOUTH ° s/?/n • MATTACM[ S .4 �,:Icama,ea 66* Application for a Permit to Build No. (4 UPON FINAL APPROVAL P> 661I a `MAP 32' LOT y1 FEE MUST ACCOMPANY THIS APPLICATION. '-DATE .Pf9 19 90 The undersigned hereby applies for a permit to build g7/ 3 according to the following specifications n �j// 93 1. Name of property owner tonYle� S f9nnA G. /o 1M Tel. 775 x673 NAddress ,4 /,/i9 1/1� &flee// Rd. UJ.I{`�nAmod}{ n4A oa67.3 2.Name of Architect(if any) Tel. - a Name of builder AV& NAR 6DR Ethel gavels Address/yo GRea r lt&srerd al. S.hPDD,s 4. License No. Tel. 5. Name of Mason Address 6. License No. /i/99'/ Tel. Noh.7. Construction address OiOJ eRitee///Pc,. Nino?o v , 0 08673 FlooDistrict 8. Date of subdivision Approval plain zone G Zone R` 9. Private dwelling 0 Estimated Cost ` •r. DO NOT WRITE IN THIS SPACE 81_13 /d'%o;odd.�p Type of room No. 10. Multi family 0 \r/rS33, 00 �1u� ops 11. Commercial 0 pa /o / x /y/ Kitchen 12. Other 0 �d�� ,� Dining Rm. 13. No. of stories , 442 Sz e— Living Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 f o • �O Pie Bed Rm. d.L Bath 15. Materials — Wood 0 Cement 0 Other 0 / Deck 16.Type of heat —, Oil 0 Gas 0 Electric ❑ Other 0 Closed porch 17. Garage — 1 0 2 0 Family Rm. Sun room 18. Swimming pool - Size Garage„, \19. Storage shed — Size /DTX /d " Shed Mx(Z 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 \Signature /_ . /I& , - • PLANNING BOARD ' Address Pa • ' • , / " mel, Date /U. ' d/vir "'l' /c`Q 0,2675 ,- - - • ' TOWN OF YAMOUTH BUILDING DEPARTMENT . - ;HOMEOWNER'LICENSE • • a I TION PLEASE PRINT:I /� /� DATE all /9'f%'3 ' /-I JOB LOCATION rix ,0/!7J' ada/e/l 14 12/eY )/6RMU (//'1 4A. 0x673 !!N//UMBERq / / . - STREET ADDRESS S CTION OF,TOWN . \"HorrEowNER"K/)4(43.711)/14 41 /!! in 77-57-0'4g 7X v 79'7 . NAME HOME PHONE WORK PHONE ESENT MAILING ADRESS /a 1 \PR /19 j)2, �p we�// AI, • (,U. 7ERMUaJ / MM 02673 CITY OR TAJWN 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 TILE OWNER ACTS AS SUPERVISOR. (STATE BUILDING CODE SECTION 109.1.1) DEFINITION OF HOMEOWNER: PERSON(S) W110 OWNS A PARCEL OF LAND ON WHICHIIE/SITE 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 14110 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 PERFORMED 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" CERTII'IES THAT HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE ' WILL COMPLY WITH SAID PROCEDURES AND REQUI' a4fitho 1 TS. \HOMEOWtER'S SIGNATURE • (�j,/�l! 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: have a current liability insurance pclicy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes j16 No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 0 Other type of indemnity 0 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 cn this permit application waives this requirement. Check one: Owner O Agent 0 Signatcre ct GA-ner cr Owner s Agent _ ___ __ _ PLOT 13CAW Th-- --.........,, .t. FOR LOT n Indicate locaton cf garage or accessory building • Additions with dashed lines Sewerage disposal (cesspool) Well 0 I I (lot ft. rear) I Cr • 4buttor's— — J I Abuttor's Vame I Name Lot # I Lot # i REAR YARD :f this is a to I, - If this �J orner lot, ` 1a corner Ic cite in name write in )f street. \ ._ I 'i ' name .of • I ct.':er u 0 a s=eer. u 2 SIDE YARD SIDE YARD HOUSE G FT. 0 0 ___ _ _ _ 0 . Q S I I SET BACK ft. 0 I 'c I 0 (lc- f`. frontace) i i ` 9.,i, 4„,_: / (NA?!E OF STREET) / \ 9 ' Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only NAME OF C1TY/tOWN Permit No. Delo AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL a I42A requires that the"reconstruct ion,alteration,renovation.repair.modernization.conversion.inprovement,removal.demolition. or construction of an addition to any preexisting owner-occupied building containing at least one but not more than.rour dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other requirements. nn/ f Type of Work: OD/ QJ�e n A /,/ Est. Cost \Address of Work 12' G� /� ,m- awe A^' GfJ7r iintw / . \ Owner Name: ;40e/ /cJ , O` I/2/2ff 67S Q woe) Date of Permit Application: /7 /p \I hereby certify that: Registration is not required for the following reason(s): Work excluded by law _Job under 51,000 By ilding not owner-occupied I,Owner 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 permit as the agent of the owner: Date Contractor Name Registration No. OR: • Notwiths nding the above notice, I hereby apply for a permit as the owner of the above property: 79 193 /G/d_ jib •..-lf Date Owner Name • • , x `� , P' ' = E COMMONWEALTH OF MASSACHUSETTS'— • • — `s :' DEFAIr:'MEWrOFINDUSTRIAL ACCIDENTS _ 1 600 WASHINGTON STREET • • games Camooei• BOSTON, MASSACHUSETTS 02111 . cpmm:sstonet WORKERS' COMPENSATION INSURANCE AFFIDAVIT • hC A/ . (licensee/permiaee) • with a principal place of business/residence at r?- '4 - . ' • � �� e/, tyme-o � $- O2l73 (City/Stat 'p) do hereby certify, under the pains and penalties of perjury, t: [) 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. [ j I am a sole proprietor, general contractor o i • •• 1 rde one)and have hired the contractors listed below sSMT who have the following workers' compensation in : ides: :+ •-- - ••• Name of Contractor . . Insurance 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 • I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents'Office of lnsuran&for coverage verification and that failure to secure overage 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 a day against me. Signed this fiQ 79 day of &,GG t , 19 9 3 ice / M LicersetiPermiret LicensoriPermiror