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HomeMy WebLinkAboutBLD-93-632 _.. ;oF•Ygk, O# i'l- .87"/1(93 WP ' . TOWN OF YARMOUTH © kFew ?pills O �...i.4 y; • MATTACME 5 � v4......�.• ' Application for a Permit to Build No. 03 -') UPON FINAL APPROVAL g - 3_93 \ MAP IPC LOT FEE MUST ACCOMPANY THIS APPLICATION. \ DATE s 4% zlef The undersigned hereby applies fora permit to build x3'93 according to the following specificatio r/ 1/45191 � 3 1. Name of property owner xcrre.e� �, Tel.S?9 f?o/ ' Address .•51r /qtr. ��� F 2.Name ofArchitect(ifany) / " Tel. r� 3. Name of build er Me- Address syr>c , or. .1 ( 4. License No. Tel. 5. Name of Mason ' Address 6. License No. Tel. i /J �/J�, - ' N7. Construction address dpe odd iCslL sY Flood / District D_vo 8. Date of subdivision Approval lain zone C- Zone 9. Private dwelling 0 stimated Cost -�� DO NOT WRITE IN THIS SPACE t-o-1 J ...0oB' .oeZoo. Type of room No. 10. Multi family 0 �T"�" a 11. Commercial ❑ , :' Kitchen 12. Other ❑ v ;yfe 9/>e /7-, —Dining Rm. 13. No. of stories ..mairessev-407- , G-t7 Bed Rmm 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 / 0 Ill(9 Bath 15. Materials — Wood 0 Cement 0 Other 0 /�.Iek- 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 e e Garage \19. Sto fished Size __fir/2•C pxiz �Xf2- / 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 I 23. Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from line or street" Fro :r lot line / Side line 25. H.LC.R. No. - '' '' J LOT RELEASED BY \Signature /i. .af at : ..t,. / • PLANNING BOARD .dress Date dre/ //te n l/ Y"D. a - PLOT PLAN . • FOR LOT # i` Indicate location of garage or accessory building k` ,' , Additions with dashed lines ."."---,.,___4:— CYC.. ' '< f' 'Sewerage disposal' (cesspool) ' (.f) ,j , t ,' ,-22/ Well-0 y s:,•. -.../---7,e..... �j f�j;A, , ? ,: , el , It " le:: di.,.. �10�✓'. . . . �l. .: "'fEgear) 1...../.: ,,,,.. ' .'.• ' Abuttor's �..„...rt,`.'�'. r -..'r i'.�. ' Abut Name I Name 7, icy/.,,,, Lot # • • -�."%"`,'... Lot' ft . . REAR YARD If this is a -= If t2 " corner lot, ..ft. Lai . coe write in name 1 . /great' �/4149fm writ of street. / I :' 0 name ,� j� • . ./,re ,i,." 7. . ' , . . a ..othe A • .. . . `d ) stree ra • SIDE YARD . • • SIDE YARD • HOUSE FT. r\ (I FT.') . • • • •I�' I - , • ' , •. • 'BCK ' • r s `-/ , ✓L y .. p'. 1 i .• z'.'. . { yp I I I • `d' (lot .ft. fron e) .• 1; • • \ / `'7' S d7l/r ?!. " i�: \ \ /// (NAME�OF STREET) . '., . " /; \% ,• ✓ _:. -Information 1-. , .. . ..,• _ '�' / i ,. . •Supplied by' • uc�'-4 ;\ PP TOWN OF YAMOUTH _ . _ BUILDING DEPARTMENT . _. - HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE / JOB LOCATION ;� S , • �Ij/�' D/Y, g Scrf / /J . , IBER•. - :' TREET' DRESS SECTION OF,TOWN / "HOMEOWNER" 4.€ ,,.' , 'i I.L' L7/ NAME HOME PHONE WORK PHONE � • ( �., ,� . � , 'ate ,• .,.- PRESENT MAILING ADRESS - - -O.le - 9 CITY OR ,TOWN - STATE . ( .•7 :/•ZIP CODE THE CURRENT EXEMPTION FOR "HOMEOWNER" WAS EXTENDED TO INCLUDE OWNER-OCCUPIED DWELLINGS OF SIX UNITS OR LESS AND TO ALLOW SUCH HOMEOWNERS TO ENGAGE AN IN • - DIVIDUAL FOR HIRE WINO DOES NOT POSSESS A LICENSE, PROVIDED THAT THE OWNER ACTS AS SUPERVISOR. (STATE BUILDING CODE SECTION 109.1.1) - -- DEFINITION OF HOMEOWNER: - PERSON(S) WHO OWNS A PARCEL OF LAND ON WHICH HE/SHE RESIDES OR INTENDS TO RE- _ - _ SIDE, ON WHICH THERE IS, OR IS INTENDED TO BE A ONE TO SIX FAMILY DWELLING, ATTACHED OR DETACHED STRUCTURES ACCESSORY TO SUCH USE AND/OR FARM-STRUCTURES. _- . A PERSON W110 CONSTRUCTS MORE THAN ONE HOME IN A TWO-YEAR PERIOD SHALL NOT BE CONSIDERED A HOMEOWNER. SUCH "HOMEOWNER" SHALL SUBMIT TO THE BUILDING OFFICIAL, ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT HE/SHE SHALL BE RESPONSIBLE FOR ALL SUCH WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1) THE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH THE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGULATIONS. • THE UNDERSIGNED "HOMEOWNER" CERTITIES THAT BE/SHE UNDERSTANDS THE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INS •CTION PROCEDURES . REQUIREMENTS AND THAT HE/SHE WILL COMPLY WITH SAID PROCED AND RE' a HOMEOWNER'S SIGNA ,&4T ties / �iii APPROVAL OF BUILDING OFFICIAL NOTE: THREE FAMILY DWELLINGS 35,000 CUBIC FEET, OR LARGER, WILL BE REQUIRED TO COMPLY WITH STATE BUILDING CODE SECTION 127.0, CONSTRUCTION CONTROL. INSURANCE COVER GE: I have a current I •Ltty insurance policy or fts substantial equivalent which meets the requirements of MGL Ch. 142. Yes No D If you have checked vis;please indicate the type coverage by checking the appropriate box. J f A liabiI ty Insurance/policy 0 .•"1 'Other type of indemnity 0 Bend 0 OWNER'S INSURANCE WAIVER' l'am aware. that the licensee does not have the insuranc/coverage required by Chapter 1S f the Ma e en ^ws, and that my signature cn this permft applicatic waivesfthis regGirement. Ch ore: „Are— A, r e-j, !Owrer t Agent D•;`,• - S gnatcre of Owner Omer s Agt.nt __ --- 'v= •�` COMMONWEALTH OF MASSACHUSETTS f DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 WASfIINGTON STREET-',! . • James.; Camooeu, BOSTONMA.S'SACHUSETTS 02111 • CommissionerF '21 1 WO RS' COMPENSATION INSURANCE AFFIDAVIT (licensee/permit-tee) , /• with a principal place of business/residence an ! " ,--„,/; %r!;' L �' cc A ���^ 4. �.' A % ' oa6e 7 . : .. (City/State/Zip) do hereby certify, under' the pains and penalties of perjury,than,., ice: rkers compensation cover`ag [) I am an employer providing the following woe.for my employees working on this a job. : :' :% ,;,.'' , :: Insurance Company i " —_ `Policy Number [ j I am a sole proprietor and have no one working for me. [ j I am a sole proprietor, general contractor ohomeowner 'rde 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 . , - - ' Name of ContractorInsurance Company/Policy Number . - 1 am a homeowner performing allcthe woric myself. :';/4�'r 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 homeowoer 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' Ofilce of Insurance for coverage verification and thai failure to secure coverage as required under Section 25A'of MGL 152 can lead to the imposition of criminal penalties • consisting of atne of up to 1500.00 an or im• ' onment of up to one year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day me. Signed th t' Q?r,/ j fsoe/�/� day of.' .jj// , 19 93 . ' Licensee/Permitter Licensor/Permirtor ' Suggested Affidavit for Home Improvement Contractor Permit Application - . • For omce Use Only - N OF CI OWN Permit No. i4/L/1/065 Date ' f" / , j f%, AFFIDAVIT • 7 Ilome.Iinprovement Contractor Law '11 1 • !'-' •./' Supplement to Permit Application t MGLe.142A requires that the"reconstruction.alteration.renovation,certair,modernizeuon.conversion.inprovement.removal.demolition. or construction of an addition to env preteistinu avnerloccuojed buddinc,containik al least one but not more than four dwelling unjts....or • to structures which are adjacent to such residence orhuildin•"be done b registered contractors,with'cenain'aeeptions,along with other "/ requirements. - /%' i / e • - CD• Type of Work: i 7.49 Est. Cost /16d Address of Work 4 .i� / - ir Owner Name: ./ i re �/ • Date of Permit Application: Age#— • I hereby certify that: , • Registration is not required for the following reason(s): • Work excluded by law _Job under S1A00 _Building not owner-occupied ,jitwner 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 c1d2.- f ' • G Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner:• • • Date Contractor Name Registration No. • OR: • Notwithstanding the above no :I hcrch • y forA,rmit ass the %•ncr of the above property: •6- r Date ON er Name