HomeMy WebLinkAboutBLD-93-613 if•Yqi•• 51//b3
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APPLICANT: CSi Qf/ . T Lt) oOG.9 ,c to BUILLDING PERMIT #:
ADDRESS 5� A/Je 7/ g �/� FELE `?: .—noon -3 /8G DATE FILED:
BLDG. SITE LOCATION: „Sf7flF MAP/I: // Z LOT//: /f
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 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 TUE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR
ISSUING THE REQUIRED BUILDING PERMIT:
REVIEWED BY:
1. WATER DEPARTMENT DATE: N/A:
2. ENGINEERING DEPARTMENT: DATE: N/A:
3. CONSERVATION: DATE: N/A:
4. HEALTH DEPARTMENT /, ti /) t (i= DATE: e% - S cf 3 N/A:
UJ INDUSTRI6ALr' D/OR OMMERCIAL 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. D 7�
COMMENTS: $GDG _00Inn6- Oc' £ri-er 82 -a/C,a/ #
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Suggested Affidavit for Home Improvement Contractor Permit Application
•
-For Orrice Ilse Only : NAME OF CITY/I'OWN
Permit No.
Date
•
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL e.142A requires that the"reconstruction.alteration.renovation.renair.modernization.conversion,inprovement.removal,demolition.
or construction of an addition toanvprecrstingowner-occupied building containing at least one but not more than four dwelling units....or
to structures which are adiacent to such residence or building"be done by registered contractors,with certain-exceptions,along with other
requirements. / /
The •
of Work: a1ST)h,J41 ecL 'nt[osore— SC'I etneci Est. Cost
Address of Work SZ Pen COM e ( Ct re le gal, np 4yorr i
/
Owner Name: vu f 044-‹ . cloav 4- tUt ✓d
Date of Permit Application: -
I hcrcby certify that: ,
•
Registration is not required for the following reason(s): •
_Work excluded by law
_Job under 51,000
_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. 142.x.
•
Signed under penalties of perjury:
I hereby apply for a permit as th agent of the owner:
7/2//9_i
2/f9i 5
,�' `" '�1 (°`" /0 6 /711
Contractor NameR„
�gtstratian No.
OR: •
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
Date Ov,ner Name
•
7t
COMMONWEALTH OF MASSACHUSETTS
v^' � P -. - :DEPARTMENT OF INDUSTRIAL ACCIDENTS
. ' 600 WASHINGTON STREET
James Camvoe:, BOSTON, MASSACHUSETTS 02111 •
romn.ss,oner • .
WORKERS COMPENSATION INSURANCE AFFIDAVIT •
I, ' 4- S ,Sl ) kJ W( vtf,✓Ga ' / : ' ' I f" I R sl
(licensee/permit-Tee)
• with a principal place of business residen at: c
Y5 - W ro Co ri i c e /l ra LSP ya,in,utatityafe {�12C�• • ' `(Cityre/Zip)
do hereby certify, under the pains and penalties of perjury, that:
[ J I am an employer providing the following workers' compensation coverage for my employees working on this
job.
InsuranceurCompany 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 insuranc policies:
Name of Contractor . Insurance Company/Policy Number .... .. .
Name of Contractor Insurance Company/Policy Number • •
Name of Contractor Insurance Company/Policy Number
0 1 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
dweiiinz of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not centrally
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 legal status of an employer under the Workers' Compensation Act.
I understand that:copy of this starement will be forwarded to the Department of Industrial Accidents' Ofnee of Insurance for coverage
verification and tan:failure to secure cover-ac as recuired under Sectio., 25A'of MGL 152 an lead to ti:;: impoil:ion of criminal penalties
consisting of a fine of up to 51500.00 and/or imprisonment of up to one year and civil penaides in the form of:Stop work Order and a
fine of S100.00 a day acains:me.
Signed :his /i day of 19 '
is : ...... Lic:nsor;P:rrn:r.:r
Fa m 415—o.;nlyd In U.S A 10/67 -
WORK SHEET
Project A)11,,,g Art Estimator Item No.
r Type of Work e 10;..e(\ i rJ 1-1-L'Cl , Date 1 Sheet No.
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Application to ' .
rfie `
1i � '" ;• Old King's Highway Regional Historic District Committee -
' in the Town of Yarmouth lora3oO
3 3
2_-"'V ---i CERTIFICATE OF APPROPRIATENESS
Application is hereby made in triplicate,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter470.
Acts and Resolves of Massachusetts.1973,for proposed work as described below and on plans,drawings or photographs.
accompanying this application for.
CHECK CATEGORIES THAT APFTY: .d
1. Exterior Building Construction: O New Building 0 Addition 1i Alteratid'n "a
Indicate type of building:CI House 0 Garage ❑Commercial IR) Other rte--Enclosed "Pnrr•h '(SPF Sens 1
2. Exterior Painting:
X rs,-,
3. Signs or Billboards:❑New sign 0 Existing sign 0 Repainting existing tIgn a .'
..
4. Structure: ❑Fence 0 Wall ❑Flagpole 0 Other ^7.7 ^-
(Please read other side for explanation and requirements). µ1g1
TYPE OR PRINT LEGIBLY c„ 2 DATE 5/18/93
ADDRESS OF PROPOSED WORK 52 Kencomsett Circle ASSESSORS MAP NO.
It
OWNER Mr. & Mrs . Stuart C. Wingard ASSESSORS LOT NO. P'
HOME ADDRESS 5 Darryl Lane, Salem, N.H. 03079 TELNO. R0'-R93-9224
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public
street or way. (Attach additional sheet if necessary). V e
Mr. & Mrs. Richard Canon, 48 Kencomsett Circle; Mrs. William Martowski
1 Kencomsett Circle; Mr.& Mrs. Graham Owens , Kencomsett Circle;
Mrs. Metaxasf'te. 6A.
AGENT OR CONTRACTOR Louis G. Mancini TEL.NO. 508-689-4799
ADDRESS 55 Linehan St. Lawrence, Ma. 01841
Contractors remodeling reg. # 105674; License # 020670
DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No.8,other side),including
materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and
proposed locations of new signs. (Attach additionalgsheet, if necessary). I
• (°I2-3IAPPROVED '�• m L
YARMOUTH COMMI Signed a 1 - 0a
OKHRD TTET E g Owner-Contract Tia gent
Soace oelow line for Committee use. •
Received by H.D.C.
/ J i
Date - 14113 Tfie Certificate is he:eby =''," :',' "S.,,\ ,.-. f !• f
Date 6...7
1s}7Time �� / /�, i/ //. , ///r ( ,�' -1 L • 1
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='•L.. ffi. IMPORTANT: If Cert:hcate is approved. approval is subject to the 10 day appeal per:cc
prcrced in :'e Ac:. • j
= 3a::•c.ec _ FIease return t.. Y;:-cutn His:cr:c Dis:r:c: Camra:::ee - t
:'At Had. 114d H!. 26. 5:..:h Yarn._:n. Mass.m6.% r
w-•'••••y wti� f 'Y r.Y'!^• .t14
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OLD=KING'SH HIGHWAY-REGIONAL HISTORIC DISTRICT• CO`W1ITTEE ---
SPECIFICATION SHEET •
3 0 0 3
APPLICANT'S NAME Mr.& Mrs Stuart Wingard FOR: Porch Enclosure ( Seasonal )
52 Kencomsett Circle
FOUNDATION: COLOR
SIDING: Natural cedar shingles 93 24 • COLOR: Cedar
r)
(to match existing exterioP1 3�'
CEEY: 1° CL1 •
_TWERK in(RfA`,f1Ft;; _ COLOR:
ROOF MATERIAL: Bird asphalt PITCH: Existing COLOR: Dark grey'.
•
WINDOWS: Combination storm & screen SIZE: 2 ' -6"x6' 7"
door-Ponderosa Pine-see spec. sheet
TRD! COLOR: White
DOORS: p PROC MVA1EE COLOR:
ypRMO/0103
SanERS: COLOR:
�.G"'T:RS: Aluminum seamless • -- - - COLOR: White
( to match existing gutter)
DECK: SIZE: COLOR:
•
GARAGE DOORS:. SIZE: COLOR:
STORM WINDOWS & DOORS: COLOR:
•
SKYLIGHTS (FLAT ONLY) SIZE: COLOR:
ADDITIONAL INFORMATION: Porch floor framed w/2x10 pressure treated
Rnnm framed w/2x4
Lattice work framed-painted white
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-MT UP.It: ELEV/3TIDTVoF- TOP OF FouuD r471ON z S(, Q1
THE ToP or TNR row.,°a7ow a 2,21 FEE'1 ,asovr
THE Mi&NT-rt Pilizr or TNF Po40 RoJ01Nbw(r.
ON THE BASIS1OF MY KNOWLEDGE AND INFORMATION, I CERTIFY TO J p;
"""" 'Iv"'.-', 1^• ,thAI MbAPAJULI UP AJURVti • SSM--� •,c, '•� ofA{`..''„�
MADE ON THE GROUND TO THE NORMAL STANDARD OF CARE OFRER (4 yG ?� \t
o STANLEY. 44 /1 o LEY ,.
LAND SURVEYORS PRACTICING IN MASSACHUSETTS,, FIND THAT a' , � � RAYMONDjer47:11.1
iTHELOCATION OF THE rouN:M.71 w ,AS SHOWN HEREOF iIa " ' o 1 '� ,,WE•"` , SWEETSER 1
IS IN COMPLIANCE WITH THE CURRENT ZONING BYLAW OF THE I 4 Mo.12492,0
TOWN OF VI4RM0uTN AS TO SETBACK REQUIREMENTS.- 0 It 9F E.'I' / 1
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•+a000
,000 950DATE REVISED DATE MAP MADE 76 22,f
OCTOBER 19,1992 .
PLOT PLAN
$ ,•
' FOR LOT R //
Indicate locatcn of garage or accessory building •
Additions with dashed lines
Sewerage disposal (cesspool) ED
Well 0
IOct.... X..P.. .....ft. rear) I
kbuttor's ) 1Abuttor's
YameI Name
Lot II /DI Lot 0/2_r'
l';REAR YARD
:f this is a - 1 � : If this i
orner lot. ..f.,5Z ..ft. corner lc
ante in namer _. write in
)f s 11
treet. I . - -i'------- -I name 'of
I I . . cther
co
i 0 1 u st eet.
I
r V
1
�1 ^
SIDE YARD Sly.-.. YAP:
HOUSE 1 _
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SET
�^BACK
`TUB fr .
o I , c
I
Gr
(lot.. .././5 f`. frontage)
Gv\ '� l-4e cd Ai se•fl Circ IC
\
\ 4 (NAME.OF STREET)
\ ' J/ / / \ \ c,— . ,:_,-....,• /(/�1 u��
S/ \ rr, f /,
::A:r.E : CRT!i ?C...
• BUILDING DEPARTMENT •
• CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT: ' •1 . •
t� •
JOB LOCATION: SZ • ticenCo ►itisQY! CIroleavbl&c 1 er4
NURSES., I • '' ,, \\ ST' ET i VILLAGE
OWNER OF PROPERTY: ' „Dtv 'V 4- ' �-/l a✓d- ` •
CONSTRUCTION SUPERVISOR: r!pL t S h 1' 1bS6�� So�-�&'9-'f�Q aht e l b �,
. •
• / / NAME / _ .� LICENSE NO. PHONE NO.
ADDRESS: 6S Li�l,aa Si/ L4 y , wee Pita: D/re(
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
CC?^_•!ONWEALTH, 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:
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 BUILDIN
OFFICIAL. •
INSURANCE COVERAGE:
I have a curr4nt iability insurance pclicy or its substantial equivalent which meets the requiremnt
es of MGLth.152
Yes . No 0
If you have checked v_s• ^,:ease inCiczte the type coverage by checking the apprcpriate box.
1
A liability insurance pc:icy AI, Caner type of :..demnity 0 Bend 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does rot have the insurance coverage requires tv
Chapter 152 of the Mass. General L-ws, ane that my signature on tris permit cpp:lea:ion waives this req_irerrer.
Check one:
Owner; Agent 0
vo"Ii Signature or Owner or Owner s Agent
SIGNATURE: . BUILDING OFFICIAL APPROVAL: