HomeMy WebLinkAboutBLD-93-626 t ro•
TOWN OF YARMOUTH C �i P/�/9� •
*fele ed.- Applic�ion for a Permit to Build No. 6074 ,
UPON FINAL APPROVAL" -93 MAP 6r LOT 10 &I
FEE MUST ACCOMPANY THIS APPLICATION. DATE 19 93
The undersigned hereby applies for a permit to build V Ar
according to the following specifications �7Zef/23
1. Name of property owner th;a./..._ LC.ve.16_ Tel. 77.. 62 7/
Address a. Ghaw+ "R.c.a. cot sd1 Yw�. ..'7t-
2.Name ofArchitect(if any) Tel.�/ I
3. Name of builder .0 . ' 1c _ ._ •ddress 70 ilo t.
lo , iL
4. License No. Tel. 3 f€9-7277 77 SO4t. Yu`" - i
5. Name of Mason Address .
6. License No. _. Tel.
7. Construction address 2 c. _-71- V..oe.Q wegcf )�
Flood cDistrict /.v_ z/p
8. Date of subdivision Approval plain zone Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
10. Multi family 0 pap a ? $r 1 P- t rt-oz F Type of room No.
' ISA Pk a. - /Civralift tit PA-/,e-- l
11. Commercial 0 8 . t-d.n.etr-c--- Kitchen
12. Other ❑ Dining Rm.
13. No. of stories _P4rA-r cat 15 Or" Dining
C-4) Bed
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 0 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 ear lo i•e Side line
2
25. H.I.C.R. No. /0 350 ,��/ /�
LOT RELEASED BY Signature f
PLANNING BOARD Address/ 7pD ,Ff„��t,76'c.
Date cbv 74.4_,..-",.. 7i
' BUILDING DEPARTMENT :
• •1 CONSTRUCTION SUPERVISOR FORM i
PLEASE PRINT:_• - . .
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• JOB LOCATION6y, I D J2eS6- Y .na,,:UMBER !/ STREET
VILLAGE OF PROPERTY: ' I-Mt t_l.C:_•_.) , 4 ..t (.c._
CONSTRUCTION SUPERVISOR: V t • . 1 . CW v. , 1 '
NAME • LICENSE NO. • PHONE N0, .
ADDRESS: O k •
�uw
J Imo.... ��� cets.d
LICENSED DESIGNEE: i
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(IF OTHER THAN SUPERVISOR) NAME LICENSE NO. j
2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: ' etH tC0 HU�iE IMPROVEMENT lAC.
•
70 Huntington Avenue
2.15.1 THE LICENSE HOLDER SHALL BE FULLY AND COMELETELY RESPONSIBLE' FORS' .L*OAC 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 TH: BUILDING OFFICIAL
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2.15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION. RECONSTRUCTION,
ALTERATION, REPAIR, RD!OVAL OR DEMlOLITION IN;OLVING THE STRUCTURAL. ELEMENTS OF BUILDING
AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE ::
CC.'"!ONLCEAL H, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB- '
CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER.
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2.15.3 THE LICENSE HOLDER SHALL Lu*!EDIATELY NOTIFY THE BUILDING OFFICIAL. IN WRITING OF THE 4 1DISCOVERY OF ANY VIOLATIONS WHICH ARE COVERED BY THE BUILDING PERMIT.
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2.15.+ 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. .
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2.15. ALL BUILDING PERMIT APPLICATIONS SHALL CONTAIN THE NAME. SIGNATURE AND LICENSE. NUMBER 0: '
HECONSTRUCTION SUPERVISOR RHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECON-
S: UC:ION, .ALTERATION. REPAIR, Rf!OVAL OF DD!OLITION AS REGULATED BY SECTION 109.1.: OF THE • I
CCC' AND TSESE RULES AND REGULATIONS. •I:: 1-1E EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISE I
SAID PERSONS, THE WORK SHALL I:_^.EDIATE Y CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTE: ;
ON THE RECORDS OF THE 3UILDING DEPARTMENT.
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I EWE READ AND UNDERSTAND MY RESFONSIBILITIES UNDER THE RULES AND REQ' g NS ;
g-- .,..LATIO\5 . OR ..CE: I::G
+:• SUPERVISORS IN ACCORDANCE :CITE SECTION 109.1.1 OF TIF. STATE BUILDING t
CONSTRUCTIONTHE L I::G CODE. I LBUILII'
OFFICIALINS: ON PRCC'z RES AND THE 'SPECIFIC INSPECTION AS CALLED FOR SY LD
THE•3Ui:
INSURANCE CCVERACE: •
I have a :e. a^:;i;y insurance pc;ic• c::;s sins::n:!:1 ec_:va;ent •.vh;c- - , ,.. ,
Ye: �� No ( , ' - :he r_ c;re.-ants c!Mat:1.152
If you have ccreel_ ac_ inc:c=._
:..- ";.-- -'re.-e by checxiy . - -_=.cena:e
box.liability insurance pc:z, C:.`.er type cf acernn:ty
0 Bona 0 •
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Suggested Affidavit fOr Home Improvement Contractor Permit Application . ..
• • Toi omce Use only. NAME.W. CITY/TOWN
Permit No. • Y(,at.•%.tales •••
-Date • • .
• AI•MllAVIT
Borne Improvement Contractor Lnw ,
Supplement to Permit Application
' MGLe.142Arequires thatthe"reconstruction.alteration.renovation•repair.modernization.conversion.inorovement.removaLdemolition
or eonstructioh°ran addition to any pre-misting building containing at least one but not more than fourdwelline units....or
to strictures which are adjacent to such residence ci building"be done by registered con tractors.with certain Inceptions,along with other. •
requirements. (� - • .
Type •
of Work: ��lrr� kw? (Loo C7" at. Cost o �"
.Address of Work •
M_ . — _ 2. _ S1 .. ( • •
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. Owner Name: it �a"CLa t. 1..,4✓L t dt 1-
L
Date of Permit Application: A" /7 /if J ,_
'v
I hereby certify that: •
Registration Is not required for the following reason(s): . •
• Work excluded by law • . i o
_Job under$1,000
_Building •not owner•occupied f
• __Owner pulling own permit
Other (specify) _ .
Notice.Is hereby given that: y
. •'OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED' 1 •
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE •t• •
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL—' c. 142A.
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Signed under penalties of perjury:
I hereby apply for a permitJJta� 'cast
the agent of the ownerr: •
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Date/? —f3 4 t st /03? o2L
Contractor Name Registration No.
OR:
A
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
Date Owner Name •
'Hi MUD it9E: IStg4VEQsEttC t,.:. ;;;n NW( IMP?jN(MENT INC.
(y���,. :o Hwittn�tori Avoitttti
es tiiiio 1t. XIS) �4 tt, q ''•-j "It?rltl f•
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