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Home My WebLink AboutBLD-93-617 i3/4 • r- , o TOWN OF YARMOUTH g/f1(g3 0 . H' �' "< �5 / Application for a Permit to Build No. 1 � �-' APP P� �—� UPON FINAL APPROVAL %''�1-Li3 MAP 6o n LOT +- L( FEE MUST ACCOMPANY THIS APPLICATION. DATE Avgu5-f 17 1993 The undersigned hereby applies for a permit to build Q/i 7193 according to the following specifications O 1. Name of property ownerP7a -Delmer- Rker ! e9 Tel. 3711-4304f Addressal 5/-)A. s RoarD So a+1, JJr,r oo-1.1,. PIA 2.Name of Architect(if any) Tel. 3. Name of builder George 1a r,S Bo;lders Address 3 lis n or Ed. S. De n n.3. 4. License No. 066130 Tel. 39 9 -0R3 A 5. Name of Mason _Address 6. License No. " Tel. 7. Construction address at 5f,'1c5 Rd, So .-)+G, A rn,nu+). Flood District ��0 8. Date of subdivision Approval plain zone C Zone 9. Private dwelling X Estimated Cost DO NOT WRITE IN THIS SPACE Type of room No. 10. Multi family 0 2, SZo 6 - 2 bhiR 5 11. Commercial 0 p_ 000Ir9 Kitchbn 12. Other ❑ 7-il�, t'`"{'<-rt p_,.,pc Dining Rm. 13. No. of stories 1 Uig• a Gere Living Rm. 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 ❑ Closed porch 17. Garage — 1 0 2 ❑ Family Rm. 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 line Side line 25. H.I.C.R. No. I o , 333 LOT RELEASED BY Signature PLANNING BOARD Address .3 Yom.,+-t Rd Date So.. I\,-..r , f"`A- TOWN OF DENNIS BUILDING DEPARTMENT . CONSTRUCTION SUPERVISOR FORM • PLEASE PRINT : DATE /4 uS+ ) 7. /993 JOB LOCATION a/ C)/fl ls /Data Sou .fd, Ar.n•,ou.},& NUMBER STREET VILLAGE OWNER OF PROPERTY FIJI? De ...cc-- Ake. rIey CONSTRUCTION • SUPERVISOR Geonqe- 06_v .'s gu ,•Id r-s tfl/3o 3q1 -o83a NAME LICENSE NUMBER PHONE , ADDRESS 3 j/eno,,,, ec1. So043, Den n,'s MA 0.76 CM NUMBER STREET CITY/TOWN STATE ZIP CODE LICENSED DESIGNEE ' (IF OTHER THAN SUPERVISOR) NAME LICENSE NUMBER 2. 15 RESPONSIBILITY OF EACH LICENSE HOLDER: S 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 t 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 struc- g tureal elements of buildings and structures only pursuant to the State Building t Code and all other applicable Laws of the Commonwealth even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. • 2. 15. 3 The license holder shall immediately notify the building official in 1 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 Sections 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, reconstruction, alteration, repair, removal or demolition as regulated by Section 109.1.1 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 construction supervisors in accordance with Section 109.1. 1 of the State Building Code. I understand the construction inspection procedures and the specific inspections as called for by the building official. SIGNATURE • (LICENSED CONS UCTION SUPERVISOR BUILDING OFFICIAL APPROVAL • 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 MGL c.142Arequires that the"reconstruction.alteration.renovation.repair,modernization.conversion.inprovernent.removal.demolition. or construction of an addition to any pre-es-is:mg owner-eccunied hmlding containing at least one but not more than four dwelling mntc....or to structures which are adjacent to such residence or budding"be done by registered contractors,with certain exceptions,along with other • requirements. Type of Work: Roo. Rep)aceMcnf Est. Cost 2(Sb0 • Address of Work 01 5-f a'le s goad- . SDL.'44, iar er ouf1, mR. O.?66ef Owner Name: T2_ pc)ete r— Ake r !el • Date of Permit Application: Av5u 5+ 17, /993 I hereby 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: .t 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. I42A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: 9r( 1 -73 �o �� _ /2r S 10 `733 Date Contrlctor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date O1tner Name ___ ..__ COMMONWEALTH OF MASSACHUSETTS ^ r i�EIAlr:hiFhTOFI?�TDUSTRLALACCIDENl"S ' 600 WASHINGTON STREET • I a tames J Camvoet; BOSTON, MASSACHUSETTS 02111 • 1 Comm:Ss/one' • • - s WORKERS' COMPENSATION INSURANCE AFFIDAVIT . p 1, _Gnr-eay, s (licensee/permittee) • with a principal place of business/residence an • 3 Venom �o .4 5n,,,-1•L. .Dtnn , 's. 1nA r CO (Ciry/State/Zip) do hereby certify, under the pains and penalties of perjury, that: ° 01.-:. 111 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. H) I am a sole proprietor. cenend contractor or homeowner (circle one) and have hired the cen_raaors listed below who have the following workers' compensation insurance policies: Name of Contractor . . Insurance Company/Policy Number __ . Name of Contractor Insurance Company/Policy Numb:: Name of Contractor Insurance Company/Policy Numb:: , 0 1 am a homeowner performing all the work myself. NOTE:.Plea c be aware that while homeowners who employ persoos to do maintenance, conatrucion or repair work on a dwciiine of not more than three units is "Mich the homeowner aisa resides or on the grounds aopunenant thereto arc not generally considered to be employer: under the Workers' Compensation Act (CL C. 152,net. 1(5)), application by a homeowner for a license or permit nay evidence the Jer'J status of an employer under the Workers' Cart eusation Act. I understand that : cop.•of this statement will be forwarded to the Department of industrial Aeddcat3' 0774' o1 :asu-n for coverage vctii::non and that ' . ' failure to ;cure coveter: as rceu:r.: undo: Sc^en 25A'of MGi I5. era lead to the impo:ipca of cd^:r:i penalties censis:ac of: 5ae of up to 51500.00 and/or in:orison:te:t of u: to one ver and dvii penalties ' c:: farm o: :_ _: —.Cork Ordc: :nd a line of!)00.00 : day again:: ;-.. '^ y Signed ;.^t5 da; or W•i'1S Si" , 19 1 , L✓/ '..•..._....... _.....-it �. Y s. .