HomeMy WebLinkAboutBLD-93-625 oF'Ygk• ., OG%C F/9`�3
� 4 ', TOWN OF YARMOUTH
V,,"4'"` " , Application for a Permit to Build No. 6 as.
UPON FINAL APPROVAL P 'ao_93 MAP 6 E LOT X 3a
FEE MUST ACCOMPANY THIS APPLICATION. DATEIAwl7, 19 93
The undersigned hereby appliesfor a permit to build ' J 24o/95 accoding to the following specifications
1. Name ofproperty oviiner tAvi. MkII:ft% S. WL.:kms Te1J98-980d'
Address___S2. C...14. 134-co N koccC Sam . Yen-s.,--ft.
2.Name ofArchitect(if any) _'i, Tel.
a Name of builder MCk. ' Mc.?ALPS ke y Address 70 tbsch:5+esw IL &4* 3/4......44.
4. License No. Tel 8 —7277
5. Name of Mason Address
6. License No. ° Tel.
7. Construction address Sot C' 4,. chow Ql of S 4L YaAdmai i;
Flood CDistrict p te 0
8. Date of subdivision Approval plain zone Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
10. Multi family 0 000e a° ��p2t i'- "° Type of room No.
r APa`Ynritint. ffe:to-,"2- l
11. Commercial 0 3-h,,3 cs- 1-.,cho0 S— • Kitchen
12. Other ❑ -a- ear. v c cfs Dining Rm.
, a .S o Living Rm.
13. No. of stories 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 0 Closed porch
17. Garage — 1 ❑ 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size _ Garage
- 19. Storage shed — Size Shed
2a Stove — Wood 0 Coal 0 1_ 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 lin Side line
25. H.I.C.R. No. l0.39-2-C
LOT RELEASED BY Signature ei
PLANNING BOARD Addres / ,opkt...- - i
i
Date gau th.. y..,......-f
1 \ -
• Suggested Affidavit for Home Improvement Contractor Permit Application .
•
• •'Foiomee Use only tI)p-�,{'E OF TY(TOWN ! • . •
- •
Per
•Date
. • AFFIDAVIT • ,
Home Improvement Contractor Law
Supplement to Permit Application . :• : '
• MGLe.l<2A requires that the'reconstruction.alien tion.renovation.repair,modernization,conversion.inorovement,removal•demolition,.
oreonstructioh of an addition toanv pre-ecistineowner-occupied building tonlainin g 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 tcnain axceptions,along with other_•. '
tsquiremenu. e+ .-
• Type of Work: c5t}'t..1 y. I e Aso �S' Est. Cost'e7Ooo •s+ •
.Address of Work �a . I,4 . aw« .• ,,
•
. �^ - �/ ),,./ •
Owner Name: . •(Vj..S, • W. f(ICts,... GUI.,,du_
Date of Permit Application: y/ 0-3 ,.
•I hereby certify that: •
•
' Registration is not required for the following reason(s): .
• Work excluded by law ' . „r
Job under 51,000 • • ' •
•
_Buildittg not owner•occupied ,
• _Owner pulling own permit .
' _Other (specify) . . ,
Notice,is hereby given that: • +
•
. - .'OWNERS—PULLING THEIR OWN.PERMIT OR DEALING WITH UNREGISTERED` t
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE . •e' -
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL—• c. 141A. .
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner: •
CF/01 Ake ntA
" /` e-r6ad ty /v if a.L
Date r Contractor Name / Registration No.
.
OR:
,
Notwithstanding the above notice. I hereby apply for a permit as the owner of the above property: «
Da lb ' Owner Name • " . . .
Tgall.CO HUE I%? IQVI:UEitr tea,:,
s.n agar( IMPNNEMENT INC.
10 Huntington Avenue -
a titiscia:'it'i: k3?J U2684 (g�e)3i3- tor. ',wino
BUILDING DEPARTMENT
iCONSTRUCTION SUPERVISOR FORM
. ;. .,.'
PLEASE PRINT: • • (� ( '
• JOB LOCATION: g< ark. �� cow YL00.1 (5)04, �I�1^•41•.4v '
• NUMBER '"- STREET %/VILLAGE
OWNER OF PROPERTY: t4 - . WI(tc:to T (.( L4-.€ .
CONSTRUCTION SUPERVISOR: ICI& Ike CLigLe.V /0,3% 42e p ?a77
L NAME //(/I, •. LICENSE NO. �_I�PHONE NO. .
ADDRESS: 7 0 NowT.. Tor.. A�+� � ,Ile ¼t* &
•
LICENSED DESIGNEE: . t ,,
(IF OTHER THAN SUPERVISOR) NAME . LICENSE NO.
2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: IhErimCO HtbAIE IMPBOYEMENT INC.
•
JONintington Avenue
2.15.1 THE LICENSE HOLDER SHALL BE FULLY AND CON2LETELY RESPO:ISIBI.E' FOR'?Y.LO?Q FORSC
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,
AL_ERATION. REPAIR. REMOVAL OR DE:•!OLITION 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 LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB-
CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. . .
2.:5.3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE
DISCOVERY OF ANY VIOLATIONS W'dICH ARE COVERED BY THE BUILDING PERMIT.
2.15..1 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 NUMBER 0:
THE CO::STR UCT:ON SUPERVISOR h'FO IS TO SUPER:'ISE THOSE PERSONS ENGAGED IN CONSTRL'CT:CN, RECON-
STRUCTION. .ALTERATION. REPAIR. REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1._ OF THE
C.= AND THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISi:
SAID PERSONS, THE WORK SHALL IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTE!
ON THE RECORDS OF THE BUILDING DEPARTMENT.
I AVE READUNDERSTANDAND U:;DE.. : HY RES?O:;Si3IL7+'T'c UNDER THE RULES AND REG•71TI0N
S .FOR LICENSING :S::_--:ON SUPERVISORSACCORDANCE :ii
SECTION 109.1.1 OF TEE STATE BUILDINGRS:
CO::STRUCT:ON I'S-__ ION CODE. I LBUIL_.
THE CONSTRUCT:ON . .--. PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR 3:' iE •3UiLD:
OFFICIAL.
INSURANCE CCVERACE:
I have a r_:•:en: t�,"i ins;:•+- •
Yee of ri
=ce pc:icy Cr::s sutzt=:_1 ec_^:a:ent wilier: meet::
It you -_ No the reC_:re-erts ct:.t Cy152
have c cczed • inc:e_ e
• :•e=s; ._ ..._ :;fie _::e:;e by c.`.ecxr; •.._ _c=:e=::a:e Pee.
A tiabdity insurance pc. 'Y,(
'c� C:`:r type cr 'acemnay 0 Ecco 0 '
.C* - INSLthAnCE WAIVER• ' - ewv._ t.:. It- . ---- s :t. ..._-......2 ecverzqe
tat t.Ocw !C tf '•�z::es rcc_::c:-_.._
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