HomeMy WebLinkAboutBLD-93-611 ' ,,'OF'Y'q/'• ,
' TOWN OF YARMOUTH or n
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�,"k40etat145'f Application for a Permit to Build No. Ca /I
Coi Ail& 2',Ym
• UPON FINAL APPROVAL MAP - LOT W6
FEE MUST ACCOMPANY THIS APPLICATION. DATE13
The undersigned hereby applies for a permit to build /493
according to the following specifications /� i��/q3
1. Name of property owner lm►+s OS- ya r-'nari1 Tel.
Address'Ru-kei-s `Ri.L«- 13eaa.L CoodaeS1:0 w 5-20.4
2.Name of Architect(if any) Tel.
3. Name of builder Mtic. /fie-Ci'. s ka.- Address 7 D 14,14.: " Tit.. La- .
4. License No. Tel. c3lj 8--7.2.7 7 ,t
5. Name of Mason _Address
6. License No. Tel. 7
7. Construction address BSc Kira - t# .111.1.i1 ' //i . At /
op. •isnct
8. Date of subdivision Approval plain zone L Zone R ..._ is--
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
Type of room No.
10. Multi family 0 ..ems ab pc Ithbflits /
11. Commercial 0 �'�,.�� �„�troo� $.13< * Kitcn
12. Other 0 Dining Rm.
13. No. of stories 111. Living Rm.
Gi Bed Rm.
14. Foundation - Full 0 Half 0 Crawl 0 Slab 0 r Bath
15. Materials - Wood 0 Cement 0 Other 0 .0 ?e / Deck
16.Type of heat - Oil 0 Gas 0 Electric 0 Other 0 Closed porch
17.Garage - 1 0 2 ❑ Family Am.
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 li e
Side line
25. H.I.C.R. No. lo 35 .24 /
LOT RELEASED BY Signature e- ' 7
PLANNING BOARD Address 7 4 46 ¢c. 4-e-
Date cCcc t X4-4{.,1le
' Suggested Affidavit fOr Home Improvement Contractor Permit Application
•
• • Fol.Office Use Only NAME OF CITY/TOWN • •
Permit N>
.,Date ' ...
•
•
..r •,•'.
AFFIDAVIT • i •
• • Home Improvement Contractor Law
Supplement to Permit Application .
•
•
MOLL142Arequires that theareconstruedon,alteration.renovation,repair,modernisation,conversion.Inprovement,removal-demolition,.
orconstruettoh or an addition to any pre. isiint:_ounernccuo;ed buildingcontaining at least one but not more than(ourdwelling units...,or
•10 structures which are adjacent to such residence or building'be done by registered contractors,with certain eseeptions,along with other_•. •
requirements.
• The of Work: Ccb_�. re kso t r / /f Est. Cosi 6 S—O. CO
.Address of Work easko.4l f Rs✓„s,t,S /SOS ^.4_ (_pu ey.E St rn.1. S.Tik.t•.•� ,
• Owner Name:' �DtoR.— d � to •
•Date of Permit Application: CF—/e7—f T •
•I hereby certify that: . ' . •
• Registration Is not required for the following reason(s): 't:
• Work excluded by lawI. • • .me
_Job under 31,000 •
_Building not owner-occupied '
• _Owner pulling own permit , •
_Other{specify) ,. ,. •
•
Notice,is hcrcby given that:
• •:OWNERS FULLING THEIR OWN.PERMIT OR DEALING WITH'UNREGISTERED. t •
• CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE • •t• .
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MOL"
• c. 142A.
•
Signed under penalties of perjury: •
I hereby apply for a permit a en f n r•
Ea/D -9.3 j�� r:
Date Co tract-or Nam __ _D 3 9 _
Registration \o.
OR:
Notwithstanding the above notice. I hereby apply for a permit as the owner of the above propeny:
•
Date Owner Name •
TLEIWCO *IGUIE JV*QVFllEkr IAt.. '.Op UAW IMp?IhvEMENT INC.
:0 Huntington Avenue • : ,j,tlr; 44/Fin e
tit 'Yet3rCit7akN 4.41384 (E?c)Et4-7z7P t?ttrij .;� -1d77
ip 1,ch: . .
i
• BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
•
PLEASE PRINT: • ..' •I. •. •
• JOB LOCATION: PGia./C.eti•S R .1.04.- Bei erg, PSS 1 0.1:•- •
.L-74 7"t4
NUMBER •_ VILLAGE •
OWNER OF PROPERTY: • �OklN✓ 8 d( X.[... G� •
// L
CONSTRUCTION SUPERVISOR: Mt are. C .(
1' e vr [C•er /0,3y AC L.796P-72.77
• ^ ,/ NAME LICENSE NO. . PHONE NO. .
ADDRESS: 7 U /4�•vw.7-,.. oto icA:e- • ea st4t e✓
..
LICENSED DESIGNEE: • .. , •
(IF OTHER THAN SUPERVISOR) NAME LICENSE NO.
2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: "tNAii 0 HliAiE IMPRDYEMENT ItiC.
70 Huntington Avenue
2.15.1 THE LICENSE HOLDER SHALL BE FULLY AND COMELETEIY RESP6ISIBT.'t FOR`''Ci1it'*Ob TOR?WHICH HE
IS SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL.WORK IS DONE PURSUANT TO THE STAT
BUILDING CODE AND THE DRAWINGS AS APPROVED BY THE BUILDING OFFICIAL
2.:5.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION,
ALTERATION, REPAIR, RD!OVAL 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 LICENSEE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB--
CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. . .
2.15.3 THE LICENSE HOLDER SHALL L`MEDIATELY,NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE
DISCOVERY OF ANY VIOLATIONS WHICH ARE COVERED BY THE BUILDING PERMIT. •
2.15.5 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 RE:'OCATION OR SUSPENSION OF LICENSE BY THE BOARD.
•
2.15. ALL BUILDING PERMIT APPLICATIONS SHALL CONTAIN THE NAME, SIGNATURE AND LICENSE NWtBER 0:
THE CONSTRUCTION SUPERVISOR WHO IS TO SUPER:'ISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECON-
STRUCTION, ,ALTERJATION, REPAIR. REMOVAL OF DD!OLITION AS REGULATED BY SECTION 109.1.: OF THE
CC:E AND THESE RULES AND REGLLu:ONS. •IN THE EVENTSU
^ •` THAT .,r LICENSEE IS NO LONGER SUPERVISi:
SAIDPERSONS, THE WORK SHALL I:M.EDIATILY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTE:
ON THE RECORDS OF THE BUILDING DEPARTMENT.
I HAVE READ AND UNDERSTAND MY RESFONSiBILI:IES UNDER THE RULES ANDREGULATIONS FORC
S- - _ RE.. LICENSING t
:C::ON Sun-R.:HC RE IN ACCORDANCE.:ON PROCEDURES
szcno:: 9 : :
THE C:7$TRL'C:.O" T_';SR - ?? _ 10 OF THE STAT'. BUILDING CODE. I UNDERS:
.-. URES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE •BUIILD:
OFFICIAL.
1NSURAtICE CCVEAACZ. ••
I have a current !zaity .
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It you have pteicy a :: sut•stentfat ec.::va:ent wilt::: ,area Mat
h.152.. incr.:::
° rec' erts ct!.1 L C.y.152
:zed_ . _a_ inc:c_:. ... :ire _-ver:^,e by C ecxing t..e ea.:,.:nate b
A liability insurance p:::.-/ Tj C:`er type et 'ncernn:ty 0 Scnc 0 •
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