HomeMy WebLinkAboutBLD-93-608 `�` TOWN OF YARMOUTH aX *
O ~4 �\ y! o K r'a'w v//a/ 3
N at.ws sti
g Application for a Permit to Build No. �' 08
%
UPON FINAL APPROVAL & g-1313 MAP ri L. 0‘4
FEE MUST ACCOMPANY THIS APPLICATION. DATE I 19 93
The undersigned hereby applies for a permit to build r /3/93
according to the following specifications
1. Name of property owner lP £Lr to .777?-if TeL '1e-...WY2
Address p<l /eIr J/` « /)d./ / P
2.Name of Architect(if any) _ Tel.
3. Name of builder ,4 Je t 2 r c.c Address .4-er.S el
4. License No. 92 77 Te I. 9 49- f 2 y s
5. Name of Mason Address
6. License No. Tel.
7. Construction address .a-X JOCKS' /` ✓?D . )4/°-
Flood 1 District R yd
8. Date of subdivision Approval plain zone C Zone
9. Private dwelling 0 Estimated Cost G)P. DO NOT WRITE IN THIS SPACE
p Qv JJ ow Type of room No.
10. Multi family 0 7, e ol, g.4-13 /
11. Commercial 0 1/ d$'? 3 z Kitchen
12.Other gr----- /a2 si<tee il/"2 'a"2 . 'AmorNf/�A �ID Dining
Rm
.
Ont., „ te-Am:weeetc . LivingRm.13. No. of stories /-2-)C/V ---
a
a dmkapar/ Bed Rm.
14. Foundation — Full 0 Half Q Crawl 0 Slab 0 /69' �rr Bath
i S-
15. Materials — Wood-gCement 0 Other 0 ` _ Deck
16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 ..2, co Closed porch
17.Garage - 1 0 2 ❑ 0, ea Jjamily Rm.
un romlei°i'is
ir
18.Swimming pool - Size Garage I
19.Storage shed — Size J °a 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
2a 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 gd. s �- f;
PLANNING BOARD Address q'A- Avt 4A
Date pe"tee,-.r',0a AT-
APPLICANT: /1944 Cts 7,- 4i/4,4 - BUILDING PERMIT i`:
ADDRESS: eP 2,4—ye Ad .filLywa. 0- TELE. NO. : 4.75,9-��� yS DATE FILED: e/919J
BLDG. SITE LOCATION: d/ aeI .4 cc. /g MAPil: 9e LOT/E: "1(4
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 i
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 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.
TIIE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR
ISSUING TUE REQUIRED BUILDING PERMIT:
REVIEWED. DEPARTMENT BY: 1 ` i . ` DATE: p(,
L} 193 N/A:
1. WATER
2. ENGINEERING DEPARTMENT: DATE: N/A:
3. CONSERVATION: La DATE: / N/A:
4. HEALTH DEPARTMENT / '/j/ DATE: C.'/yl/f N/A:
. / •
I lUS IAL AND/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR: DATE: N/A:
G. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: 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: ,EiJ giv rf T 0.- ,PC-jni/6/J
•
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"ye:* )Jg-- .1914 .!�(�.t tvi —1 /-✓" l sae" .s1/2O,ne[t`+-
✓ . .moi .. 4 / f_ � ,
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tibia FreE Roars •13e104 .SDIJel)? 7 n- l/%o<',Y ,ft/ c934,
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13LPi/89 7Y/2 ^�
COMMONWEALTH OF MASSACHUSETTS .
DEPARTMENT OF INDUSTRIAL ACCIDENTS
�,
1, 600 WASHINGTON STREET
James Camooei. BOSTON, MASSACHUSETTS 02111 •
Comn:ssronet WORKERS' COMPENSATION INSURANCE AFFIDAVIT •
- . - i - ai.—
(licensee/permittee)
• with a principal place of business/residence an
•
4-Nig 60D rr•' o A CYY
(City/State/Zip)
do hereby certify, under the pains and penalties of perjury, that: •-. . - -
m an employer providing the following workers' compensation coverage for my employees working on this
job.
CtS rp.e4 (ix'',a Cl8/7.9 / rz
Insurance Company Policy Number
( ] 1 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 policies: r' - . • -- .1 . .
Name of Contractor Insurance Company/Policy Number.. .
Name of Contractor Insurance Company/Policy Number • -
•
Name of Contractor Insurance Company/Policy Number . _
Q 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 Insurance for coverage
verinca:ion and that failure to iecure coverage as required under Section 25A'of Iv1GL 152 cart lead to the impoiition 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 3100.00 a day against me.
Signed this (•• _ day of (ri`9 , 19 9-7
Liceaset/Permice: Licensor/Permitror
.
-- - -`TOWN OF YARMOUTH • - ." '
- -- - BUILDING DEPARTMENT • ' :'
CONSTRUCTION SUPERVISOR FORM .
PLEASE PRINT: : . .
•
JOB LOCATION: G ' dOeys ffl GG • 1/ yq2 �o.�ry fie.
. . NUMBER . STREET - VILLAGE
OWNER OF PROPERTY: • -49)///:/— � Ii
)1J,-;---7-:/ g
�� 7�,!
CONSTRUCTION SUPERVISOR: ✓l , j;-,e.t,— -nisc 6. - • - • 72 9'9 -• J7v ,Sr_i yi -
NAME LICENSE NO. PHONE NO. . .
ADDRESS: oL 29 Jy d MPivs%/, Samoa f7—
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
COfL^4ONWEALTH, 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 IMEDIATELY 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 LICENSING CC:I-
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTA :
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
OFFICIAL.
INSURANCE COVERAGE: '.
1 have a current bility insurance pclicy or its substantial equivalent which meets the requirements of MGL1Oh.152
Yes . . No0 .
•
If you have checked ves. please indicate the type c:verage by checking the apprcpriate box. .
A liability insurance pciicy O:her type of :.idemnity❑ Bond 0 - , •
OWNER'S INSURANCE WAIVER:1 am aware that the licensee dces rot have the insurance coverage require? by
Chapter 2 of the Mass: General L^ws, an that my signature an ams permit coplicaticn waives this requirerreri
• Check one:
•
/ � `f`--./��1.� • Owner: Agenta]� - '
Signal•re o Owner cr Owners Agent
SIGNATURE: BUILDING OFFICIAL APPROVAL: '
FOR LOT # . iP d
Indicate locadcn cf garage or accessory building • ,
Additions with dashed lines
Sewerage disposal (cesspool) a )
Well El
I (lot D`GO Pr ft. rear) I
4buttnr's I ' Abutter's
Vame I Name
Lot # I Lot #
REAR >RD
1 this is a If this is
�rner lot. ..2.11/ corner lc
trite' in name 1. Io ✓ �'~' Ox write in
,f street. IU 0C name 'of
C. I D� I /N c. other
u 0 u s,=eec.
u
is .., •
SIDE YARD SIDE VAR:
•
G a FT. 0 0 _ _.01-_,L _ _0 .
• "S I cIi-
SET BACK
...&0. ' .ft.
I
I
0
( ot. .(gLQ. . . . . ... . .ft. frontage)
\ / 021 Je45 be/L- O/ -
\ /
\ / (NAME OF STREET)
\ /
\ G...1:y e. �4„
—..— -. :. Applicat a
ion to
s.
i
lilt.
tt.t}� Old Kings Highway Regional Historic District Committee •
fir—i
C in the Town of Yarmouth for a ,
J
CERTIFICATION OF EXEMPTION
Application is hereby made, in triplicate, for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470,
Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans, drawings, pr photo-
graphs accompanying this application. • —
TYPE OR PRINT LEGIBLY DATE //if/ 59
ADDRESS OF PROPOSED/+ WORK &Ae 6 r /✓jte diet ASSESSORS MAP NO. / 4
/' /
OWNER / 1 /moo4 r _f J '.Lr ASSESSORS LOT NO. l'ici
HOME ADDRESS �- 6 19rof X 4,<2 Or
c i TEL. NO.
•
AGENT OR CONTRACTOR A 4 e r , i Ge--- %�i-✓ v-t,ZyU Q
ADDRESS - .14"r/F aea .40 CWAIJ is.")4,7 TEL. NO. 29
This application is for exemption of proposed exterior construction on the ground that:
es-11T) It will not be visible from any way or public place.
12) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commiss-on.
(Check applicable box)
PROPOSED \CORK: Describe and furnish plan of proposed work, showing location on lot, and, if an addition is involved, show.
ing location of existing building.
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��� 'APPROVED _ • 7>i', 0
AbsRtdOUTH COMMITTEE "`= <-^
." NJ frn r
OKHRD v,c 7:- IS1 C
SIGNED .:. •
r -
Owner-Contractor-Agent
Soace oew•.v lire for Committee use.
-
Rece:ve by HOC. The Cor trficateishereo• ^e'%A✓''r ..—r'"4"`
/%J l�..�..� ;a .._._,_ ._" �7 ,I " . ,i
Date
Time
By ci� alioJ.
d' Approved ' lThe categories of work entitled to exemption are listed on
Disapproved 0 the back of this form.
Ka, •-_ _ .. , EKTERIOR ARCHITECTURAL FEATURES 1
10
SUITABLE FOR CERTIFICATES OF EXEMPTION ' ,r� .r
r FOR RESIDENTIAL USE ONLY' .
•
FENCES: 1. Post and rail, split, half round or round; natural fiisp h _ f !t nJ rr •
2. Square rail;white or natural finish ���
3. Stockade; natural or gray stain finish;not forward of face of main building
4. Picket;white only
(Maximum height of all fencer, 4 feet)
,r
HEDGES: natural, not to exceed four feet in height "
DECKS.: constructed of wood, on single family dwellings, built after 1900, at first floor level, at the rear only,
railings not to exceed 3$ inches in height, not over 50% to be visible from a way;natural finish or color
compatible with building involved
BREEZEWAYS: enclosure of existing breezeways, consistent with style, material and color of house, excluding sliding
glass doors facing street, way or public place
FLAGPOLES: on residential property, not over 24 feet high, not less than 20 feet from way, constructed of wood, with
natural finish or painted white, or of aluminum, or of fiberglas or metal painted white
•
AR=ORS AND TRELLISES: of lightweight, woocen construction, not over nine feet high
ROOFS: natural cedar shingles, or asphalt si::ogles per approved color samples; not over five inches exoosure to
weather
. SIDING: natural cecar shingles, or wooden c.aoboards • natural or approved color; not over five incnes expp,r.re'•
to weather
•
STORM SASH, STORM DOORS, WINDOW SCREENS, SCREEN DOORS, GUTTERS AND LEADERS: permissibi? f.
consistent with style, material and color of building
LIGHT POST: permissible if consistent with style, material and color of building
AIR CONDITIONERS: portable,window units at side or rear of building - t t• ` !`
le
STONE WALLScconstcuction of field or split stone, not exceeding 30 inches in height ' -
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•
•
NOTE
1 1. All prior bulletins hereby superseded.
2. Conditions contained in certificates of appropriateness shall be binding regardless of any exempt-ons conta neo herein.
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OLD KING'S HIGH.AY REGIONAL a:STORIC DISTRICT CO`:!ITTEE
SPECIFICATION SHEET
APPLICANT'S NAME) �L2QFGL- FOR: 40B fl/S ,72),72
FOUNDATION: <.5 ) .iia f U ace• fa COLOR
•
SIDING: k/ Ci,7 Cc c'04 COLOR: Al Art
Com fl: COLOR:
ROOF MATERIAL: A PITCH: 7 COLOR: ai a LUDO
WINDOWS: 02 #the.G. s•47 .2.[..) 0 el SIZE: 4/el"
TRIM COLOR: et, u./ 4/
•
DOORS: OZ • ,J ac A-, COLOR: /./I7 / 725
SHUTTERS: COLOR:
• GUTTERS: 'y J .f LGCJ.efr COLOR: ,Cfaltt.�l
DECK: SIZE: COLOR:
GARAGE DOORS:. SIZE: COLOR:
•
STORM WINDOWS & DOORS: COLOR:
SKYLIGHTS (FLAT ONLY) a, SIZE: do a/9 C COLOR: 1/461a/l
ADDITIONAL INFORMATION: •
Suggested Affidavit for Home Improvement Contractor Permit Application
For Office Use Only NAME OF CITY/TOWN
Permit No.
Date
AFFIDAVIT
home Improvement Contractor Law
Supplement to Permit Application
MGLc.142A requires that the"reconstruction,alteration.renovation.repair.modernization.conversion.inprovement,removal.demolition.
or construction of an addition to any pre-existing owner-oecuoied hmldine containing at least one but not more than.fourdwellinr units....or
•
to structures which are adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: //1//el jii y ab e "f Est. Cost2aoo.--
Address of Work (9 X Jee-r A"-
Owner Name: .62),/./ �u r7z.r
Date of Permit Application: 4,/y/7)
I hereby certify that:
Registration is not required for the following reason(s): •
_Work excluded by law
_Job under 51,00)
_Building not owner-occupied
_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:
Cf1/473 .4f)opcti Al-2/1te /ny7702
Date Contractor Name Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
Date Owner Name