Loading...
HomeMy WebLinkAboutBLD-93-628 Y � ` �� o TOWN OF YARMOUTH ©i< Ea) 21445 • MATTACMC S 441*k....+`0 ' Applicp 'on for a Permit to Build No. 6c2 UPON FINAL APPROVAL MAP 3 5 LOT 5 • FEE MUST ACCOMPANY THIS APPLICATION. DATE fr.? 19 93 The undersigned hereby applies for a permit to build ����9.�' according to the following specifications W 2-a $,9 6/7- 1. Name of property owner Flee-{ /nnk 0-P 111055a64 cl.S�"s Tel. -Vie -30/0 Address 75 Stir Si- oos�/an, fiA dafoh 2.Name ofArchitect(if n4bJL,ani HSsocl:deS Tnc. Tel.63L-Rs4lj a Name of builder,E1, M.COnS uc-hon y f"n ddress /9A c? Sou]1 St.) &rio jpwSer 4. License No. Oa4G,07 Tel. ng-,279--/C/0 5. Name of Mason _5al)e Address .- 6. License No. Tel. P/1%, 7. Construction address rtor qhand sQ 1 gmarmottA1 HA J Flood District 8. Date of subdivision Approval plain zone G Zone L. B 9. Private dwelling ❑ Estimated Cost c# I, DO7 WRITE IN THIS SPACE g'tg- -7 Type of room'/ No. 10. Multi family ❑ L-I'10 GD, e"-- -- 46or n� y/ tfRNA (12S c ii I 11. Commercial 0r Kitchen L 12. Other ❑ g4 Dining Rm. r .r . '� LivingRm. 13. No. of stories / +• r ,, /los X S?'-7 4 366 /B Bed Rm. 14. Foundation — Full VHaif ❑ Crawla ❑W Slab ❑ 17 15. Materials — Wood ❑ Cement 0 Other ld N ��00Deck _ 16. Type of heat — Oil 0 Gas [V Electric 0 OthertSt1 -: Closed porch 17. Garage — 1 ❑ 2 ❑ _ /A6, / 0 Family Rm. 3-15 , on-_. Sun room 18. Swimming pool - Size ,l , i' ' Garage 19. Storage shed — Size 74 /0 MININa A 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. LOT RELEASED BY Signature (i..it//te2 `ri PLANNING BOARD Address /7,69- �iieV7Y/' e Date 1iP) ( //e 9lY'R /i/i� frs 4. • - APPLICANT: p Q:iw _ 7BUILDING PERMIT th _ r -o.� , / f ADDRESS: 75 / /`/fl TELE. NO. : `?V‘ 36 /6 DATE FILED: b/ f lr . BLDG. SITE LOCATION 2.,77,-2777 ),,. /..),9), g y MAP41: Lon: THE FOLLOWING INFORMATION OUTL NES 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_GOMPLIANCE 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 THE 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 /j DATE: 07/93 N/A: INDUSTRIAL /OR COMMERCIAL PERMITS 7 5. WIRING INSPECTOR: � r DATE: 8/jfr N/A: G. PLUMBING INSPECTOI L fl., ;' L1/,v Z S-� DATE: &, .),F�Y_{ 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. / COMMENTS: I3LM/89 2J/cW9y a n Y J . - TOWN OF ,YARMOUTH ' •- - • BUILDING DEPARTMENT . CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: 1.• n JOB LOCATION:R-{•,A,gi0 L 0n0tP0nc1 K�, J S0, \thrn1Dt r /1H • NUMBER U pA . ST ET VILLAGE OWNER OF PROPERTY: ' CFIeef' ' Bank 6-9 Ha 5sact u s eft CONSTRUCTION SUPERVISOR:Enrico N eodi i rrM, unr etfot1 ' . OA6607 Cor--a 7?-/c/0 - NAME LICENSE NO. _ PHONE NO. . . • . ADDRESS: 1 ' • . /A 4. ab1 _ c. ' A . 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, REIOVAL 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 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 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, RECON-' STRUCTION, ALTERATION, REPAIR, REMOVAL OF DD1OLITION 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 I}21EDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPART:4ENT. . ' I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR LICENSING CC'T•, STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTAN THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. . INSURANCE COVERAGE: • . I have a current ability insurance policy or its substantial equivalent which meets the requirements of Mth.152 • Yes current GL. . No ❑ If you have checked v`s, please indicate the type c:verage by checking the appropriate box. . A liability insurance pc:icy Other type of :.ademnity❑ Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does rot have the insurance coverage required by.. Chapter 152 of the Mass: General Lws• ana that my signature on this permit application waives this requirement • Check one: OwneruAgent 0 Signature of Comer or Owners Agent ' Q / .ti • h SIGNATURE:• L lr.-25, , O UILDING OFFICIAL APPROVAL: C • _ _ • --,-------!---z-'-- 1 s =E COMMONWEALTH OF MASSACHUSETTS -E— DEPARTMENT OF INDUSTRIAL ACCIDENTS ,L1 : t 600 WASHINGTON STREET. • . • • games J Camppel; . + BOSTON, MASSACHUSETTS 02111 • rorn:ssone: '��A1 • WORKERS' COMPENSATION INSURANCE AFFIDAVIT I, Cnr;eo rIeoi1 5. M. ( ems-fni,e_ n )Tne , (licensee/permittee) • with a principal placrl of business/ esidence at: • 19(42 Souk- 3-+., Rridie ttjcokr , MA 0a3a4 (City/Sure/Zip) do hereby certify, under the pains and penalties of perjury,that: W1 am an employer providing the following workers' compensation coverage for my employees working on this job. IA/bre-es-ter Tn 5 u.rra,n r P. @ 4 , (ora C S gos-b o l • Insurance Company Policy Number ( j I am a sole proprietor and have no one working for me. I am a sole propner. , :eneral contractor or homeowner (circle one) and have hired the contactors listed below who have the following wor ers - a .=non insurance policies: z- . EtiN ec a ; A. . 6© 6 /3 -0.C-60Y Name of Contractor . Insurance Company/Policy Number . _. .. . Name of Contractor - Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number O I 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 dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)),application by a homeowner for a license or permit may evidence the legal status of an employer under the Workers'Compensation Act I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of insurance for coverage verification and that failure to iecure coverage u required under Section 25A'of MGL 152 can lead to the imposition of criminal penalties • consisting of a fine of up to 51500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day against me. Cr Signed this 4 day of e2'��0'-d'✓ 4. , 19 /7,-�• �J/fJ lam- �J-7�li,GL e te5 —ee-a ,i License:iPermi-:e Licensor/fermi—,or PLOT PLAN • FOR LOT # • Indicate , location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) . Well I (lot ft. rear) 0 Abuttor's I Q` Abutto Name IName Lot # cji ' j Lot # N. REAR YARD • If this is a pp �,1 If thi corner lot, ft. 5110A corse write in name write of street. I name } Ilar/C a other. �./ 0 ' S�ij�h co street y SIDE YARD 4;v SIDE 1A• D • 0 co c-- FT. �te HOUSE 3y FT o ni . 1 • • . SETBACK 4, `9s.ssk I (lot ft. frontage) .. • • \ / lar t -ICC----- . \ / \ / (NAME OF STREET) • <\ \ -Information �(44-"--t--CCI `t � � ' / Supplied by 11 / / \