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Home My WebLink AboutBLD-93-631 1 .of• YAk• . . . 61 23`9 3 k,e 4 ` 'TOWN OF YARMOUTH rk Sas e�/ O E y , ,,"4 .:;.5.' "41 1 Application for a Permit to Build No. 63/ UPON FINAL APPROVAL Dj 8:" a3 -.73 MAP 5/ LOT B-67 _ FEE MUST ACCOMPANY THIS APPLICATION. DATE S >3 19 23 The undersigned hereby applies for a permit to build A3/93 according to the following specifications 1. Name of property owner klentttin Wait I Tel.??3003 Address 2t ft/ST Been 2D */il-a• 2.Name of Architect(if any) Tel. 3. Name of builder 1-1 K fi IGkc-►L3okt Address 13 VHS way os'i m LLr 4. License No. Oft 35q Tel. 9S2PAP 5. Name of Mason _Address 6. License No. Tel. 7. Construction address 2-Y f'i-ST o't-bad Flood District 8. Date of subdivision Approval plain zone e— Zone n c� 9. Private dwelling p/ Estimated Cost DO NOT WRITE IN THIS SPACE 10. Multi family0 1,SC'O�oO ffcpcncc wrrce.s- Type of room No. ( Ibmoo-w * Nat 11. Commercial 0 fkitoiceri 12. Other 0 Dining Rm. 13. No. of storiesif Living Rm. 3S: re Bed Rm. 14. Foundation — Full ❑ Half IKCrawl lYSlab 0 Bath friawn-/ok / 15. Materials — Wood e Cement 0 Other 0 Deck 16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 0 2 0 Family Rm. Sun room 18. Swimming pool - Size Garage 19. Storage shed — Size Shed 20. Stove = Wood 0 Coal ❑ 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. /0O.'60 LOT RELEASED BY Signature mill 1) r---`-- PLANNING BOARD Address / ? t' . &A *, Date (42-&--aK Kna 02_c_O- BUILDING PERMIT APPLICATION SIGN OFF APPLICANT: #1.I QsCIOSO J BUILDING PERMIT it: ADDRESS: /317/6%444i O5riAbur TELE. NO. : y1-$ 7 L8 DATE FILED: 8fV3h3 BLDG. SITE LOCATION: .4'f 7 f3 xx QO MAP#: 6/ Lou: II-67 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 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. ONSERVATION: DATE: N/A: Lk: HEALTH DEPARTMENT 4„ _^�l DATE: G—.z3 cr 3 N/A: US AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE ALL STUMPSAND/DR—BRUSHHMUST—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: BLM/89 Suggested Affidavit for Home Improvement Contractor Permit Application For orrice Use Only • NAME OF CITY/TOWN Permit Na Delo • AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.142A requires that the"reconstruction,alteration,renovation.repair,modernization.conversion,inprovement,removal.demolition. or construction of an addition to any preccisting owner-occupied budding containing at least one but not more than four dwelling units....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: kW/4170d • Est. Cost/COO, Address of Work 2/( btsr ($a= Owner Name: N01244/1-0 &Aifc- Date of Permit Application: aha j93 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under $1,000 _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 r c. I42A. Signed under penalties of perjury: I hereby apply for a permit as the agent o the ner: 0 10 ci 99 Date Contractor Name Registration No. OR: • Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name • COMMONWEALTH OF MASSACHUSETTS - - - DE I'ARTMEN''T OF LNIDUSTRIAL ACCIDENTS , - - 600 WASHINGTON STREET James J Campoeu BOSTON, MASSACHUSETTS 02111 • • Commrss+oner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • /1-17./< /1//C'/o4ggcom (licensee/permittee) • with a principal place of business/residence at.. /3 '7W6 ry,nY nsreek,cc E' ' 1,701• 02C0 3" (City/State/Zip) do hereby certify, under the pains andipenalties of perjury, that: • [) I am an employer providing the following workers' compensation coverage for my employees working on this job. • Insurance Company Policy Number 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 insurance policies: . - . . . Name of Contractor . - .. Insurance Company/Policy Number.. • Name of Contractor •• Insurance Company/Policy Number . . - .• • - • a Name of Contractor Insurance Company/Policy Number . - 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 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. • 1 understand that a copy of this statement will be forwarded to the Department of Industrial Accidents'Office of lnsurance for coverage • verification and that failure to secure coverage as required under Section 25A'of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to SI 500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of S100.00 a day against me. • Signed this .23 day of al90Gr , 19 73 • Lice: seciPermi^ec' Licensor/Permirror TOWN OF YARMOUTH • BUILDING DEPARTMENT . • CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: - . . JOB LOCATION: gv . Ftsr eeaae itD , SYR/mom NUMBER . STR£ET , VILLAGE •, . OWNER OF PROPERTY: ' 41024.M4AJ 4)?WL / -.— CONSTRUCTION SUPERVISOR: ' Plr4U/C . Oly358 ',. •_fw� t/4Vsa$ . NAME f,�� /f. r//LLLICENSE NO. ' PHONE N0. , . • ADDRESS: /3 T1/lScultY 05761 -Urut-'' iji� ' . /� . �.,..>et--, (.077c41-(<• . LICENSED DESIGNEE: • ".7S •444 r 4tec et - (IF OTHER THAN SUPERVISOR) NAME r LICENSE NO. . • 2.15 RESPONSIBILITY OF EACH LIC�S/E'HOLDE•R: • • t,j C t t •/-S' 2. J 2.15.1 THE LICENSE HOLDER SHALL BE FULLY AND COMPLETELY RESPONSIBLE FOR ALt 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 SHALIJBISIRESPONSIBLE T9#SII'ERVISE,LTHE CONSTRUCTION, RECONSTRUCTION, ALTERATION, REPAIR, REMOVAL OR 6EMOLITION 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 TOr2jE 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 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 I}ThtEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECbRDrOF,THE,,BtILDING_DEPARTYINT. e • C Clv r.'Irc , ti . • I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR LICENSING CCI- STRUCTION SUPERVISORS IN ACCORDANCE .:ITH 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 pclicy or its substantial equivalent which meets the requirements of MGLth.152 Yes . No ❑ If you have checked v`s. please indicate the type c average by checking the ap;:cpria et bet( .C.' r f % • A liability insurance pcIicy4 Other type of :.-tdertlrlity 0 ,. i, ' . Bond'Q O'NNER'S INSURANCE WAIVER: I am aware that the licensee deer not •have the ins •tante coverzgefetfuirec by.. Chapter 152 of the Mass. General L-ws, arta that my sign ature:on this-permit t ccpticatie.‹;711veShis;Eetgtrtert. A"" / %' Check cre/C '4+ ,J` I i a . ROwne?�J•"('t."•.(Agent o / 5 c y Signature or Owner or Owner s Agent SIGNATURE: /0/ % w • 4/1 BUILDING OFFICIAL APPROVAL: ~