HomeMy WebLinkAboutBLD-93-634 p /
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'kaaitteacesItS V0, Application for a Permit to Build No. 633I
UPON FINAL APPROVAL JOY ? MVP &7 LOT Cts
FEE MUST ACCOMPANY THIS APPLICATION. ' \ DATE 19 93
The undersigned hereby applies for a permit to build r/A89'3
according to the following specifications a,
"1. Name of property owner '1AV SPLEd�tnSiPP1-v` el• 39ci-0-,1
\Address lia (fMMnxRf-Alchl MF / tWAtiv,wcL1-
2.Name of Architect(if any) Tel.
N. a Name of builder. VAAJOA-co al t& 1Q4nr/ Address '3S 1--6xZ-Ft=u,o,A, '0A__
�4. License No. Tel. ��« �w�' nnA
5. Netno of Mason : Address
6. License No` Tel.
7. Construction address ttL CAMMO.NLJltibd At _ ¶c. V4MMOvctr
Flood District
8. Date of subdivision Approval plain zone G Zone /u�
9. Private dwelling 0 Estimated Cost -Mit P‘ �O NOT WRITE IN THIS SPACE
?-,913 Type of room No.
10. Multi family 0 'N. a( b.q) /OD
v ,��p Nr /
11. Commercial / ou l'C 3 Kitchen
12. Other ❑ 0 `f Dining Rm.
13. No. of stories a7 Living Rm.Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 S Bath
15. Materials — Wood 0 Cement 0 Other 0 _ /e, , ac eft Deck
16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch
17. Garage — 1 ❑ 2 ❑ t....470Family Rm.
Sun room
18. Swimming pool - SizeGarage _
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 rom rear lot line Side line
25. H.I.C.R. No.
LOT RELEASED BY \Signature a4-6" 2-
PLANNING BOARD Address Q0- �+-.oi - tLfl4 Aol—
Date 5 •N' a- nL.,cf4-, ANA / ,
APPLICANT: c- rm6S S.CCrnAc.- .iPPW BUILDING PERMIT is
ADDRES : `-t"c). [ y, FA Ami -1:7, TELE. NO. : '"j t—/a-/ / DATE FILED: Ce-23-473
BLDG. SITE LOCATION: 402 p i,64ur MAP//: • c<q-- LOU: &9--
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 COAPIERCIAL 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. .
TILE 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: f DATE: N/A:
4. HEALTH DEPARTMENT /. .� {{r DATE: (e -�/- q(J N/A:
��IND/STR AND/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR: i2�2 /t DATE: All(; - q 1293 N/A:
G. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT:LOp /(J /!/ 1211.01 DATE: 0j�0 N/A:
/f// PLEASE NOTE j'
ALL STUMPS AND/OR BRUSH MUST BE DISPOSED OF AT AN APPROVLU SITE. A SIGNED RECEIPT FROM THE
DISPOSAL SITE 'MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING
PERMIT.
COMMENTS: t). /�./,�.ee' °A/ xe'<A� /�//A� 7.207- S I. %7,P
as, a(, Iggl .
A:ii) - .r1 1323
BLM/89
TOWN OFYARMOUTH •
BUILDING DEPARTMENT
• - .6 . . . - CONSTRUCTION SUPERVISOR FORM • -• •-
PLEASE PRINT: '. _ :. /''
JOB LOCATION: 7a • Coivonni jSVA AVE- c9. (N\&C'KT •
NUMBS • / . ' . STREET • . VILLAGE
OWNER OF PROPERTY: ' yM 15, 6- LFit1I A( 5—: 710l>/ •
CONSTRUCTION SUPERVISOR: , C)1�6*-CAJffl -.rr cf-(IAf�V
•
NAME LICENSE NO. PHONE NO. • .
ADDRESS:' 3 J LO .NC a4-4.ti/ QA G/h : C t..«t u' : - pnQ
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, REMOVAL 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 3E 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 IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED
ON THE RECORDS OF THE BUILDING DEPART`:ENT.
I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR .ICENSING CC:I-
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 liability insurance policy or its substantial equivalent which meets the requirements of MGL�th.152
Yes O . No ■ •
If you have checked v`s. please indicate the type c average by checking the appropriate box.
ti
A liability insurance pc:icy 0 Other type of :.idemnity 0 Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee doei rat have the insurance coverage required by
Chapter 152 of the Mass: General Laws, anc that my signature on tns permit acplication waives this requirement.
/� • Check one: ,
!/ Owner° Agent 0
Signaler at Own or liners Agent / •
SIGNATURE:� .l r--J BUILDING OFFICIAL APPROVAL: ~
* FOR LOT �i MAP V1
Indicate locat,'cn cf garage or accessory building •
Additions with dashed lines
Sewerage disposal (cesspool) C
Well m
.• I
I (lot ft. rear) I
kbuttor's I Abuttor's
game I Name
Lot # I Lot #
REAR YARD
:f this is a - If this •
orner lot, a(1.) ft. corner to
cite in name I • write in
)f street. I f iname 'of
•
I ^ otter
U
0 u street.
U
I (�1 SIDE YAR I to -c SIDE YASO
\ HOUSE -- - - -
Q
r •
I
X-bi4 SET BACK
•
, 60 ft c •
I
I '
0r (-tap f`. L—cntace)
•
/ COmAt coaw rAttti Av�ti.(,E--
\ /
\ / (NAME OF STREET)
i
/ \ -1At-e_craitAc-14,6
,
f--
_m= =- COMMONWEALTH OF MASSACHUSETTS
P_ — moo• t
—_ DEPAR:'MENT OF LNDUSTRIAL ACCIDENTS
1' • 600 WASHINGTON STREET •
James Campoei; BOSTON, MASSACHUSETTS 02111 '
Commrss oner WORKERS' COMPENSATION INSURANCE AFFIDAVIT •
I, (.r came L•,s re i, ' V E Cr .
(licensee/permittee)
• with a principal place of business/residence an -- -
4a COMm6>,;wttits14 Aad— S(). Yen.rv+aiClA—
(Cicy/Staccaip)
do hereby certify, under the pains and penalties of perjury,that: - . _ . .
N I am an employer providing the following workers' compensation coverage for my employees working on this
job.
Insurance Company Policy Number
( 3 1 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
w o have the following workers' om nation insurance policies:
bk.)06:6-Covettire-AftH%N.Naf---6 twig NN:j
Name of Contractor . Insurance Company/Policy Number . ... .. .
Name of Contractor - Insurance Company/Policy Number .
Name of Contractor Insurance Company/Policy Number
0 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 fora license
or permit may evidence the legal sums 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;enure 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 S 100.00 a day against me. i
Si ned this F-20t/r4-1, day of 4»S` u f+— , 19 Q3
J./ ' GM ,l, ' .
Licersee/Permi:tet Qgylvr - CLECrti&c. LicensoriPermittor
gc.•S �i `Y• Iffill litiT'i 'tilI 1fi- t 1 alai fa t 1 ? IM 4Ri 'I RIVITalii tiffl'.1 1 4.
Certificate icater-i . o . atne : :. efiW ance q
BY .
�s REGISTERED :: : . ,<ISSUED Dare •
tM
o•',+• . • FABRIC SNYDER MANUFACTURING CO. manufactured
:� ' HUMBER
- ,��. ; o- - 3001 PROGRESS-STREET-•
c DOVER,OHIO 446.22 2/19/88
ra
• F-110 . .
• This is to certify that the
G' materials described on fhe reverse side hereof have been flame- r
retardant Treated (or are mherenfly rronflammab[eJ: , j:
;r
FOR Top-Tec _— ADDRESS 1905 U.F. Main Street
'J.2�6Ri
•
`. sonvi11e , • - : :•.. .:. •• •:: •c _:.-'-::STATE' —
CITY -11RF - - �= •- '
Certification is.hereby.rriride.that:'(Check.'a" or:"b",�: 'a • .
(a) The articles described on the reverse side of this Certificate have been treated with a flame-retardant '-
Q chemical approved and registered by the State Fire Marshal and that+the application of said
•
chemical was done in conformance with'the lows of the State of California and the Rules and 3
• y Regulations of the State Fire Marshal: P
S Name of chemical used Chem. Reg. No:.:._................._..... .-
•Method of application
r (b) The articles described on the reverse side hereof are made from a flame-resistant fabric or material
. ),.1 . registered and approved by the State Fire Marshal for such use.
•
- • Trade name of flame-resistant fabric or material used PRV-Reg.No. F-140.O1
- The Flame Retardant Process Used WILL NOT Be Removed By Washing
• SNYDER MANUFACTURING CO. ByAl ��p ' �(t,
o Tom Kelker S tervisor t al i v Control t . -
:-- T:fte AI'5 Name of Production Superintendent "-
�liait i t{iSi>lfit{n{t I dil:{i T1tigt (1&1 t(7S1?IfA1I11•C;ifilllSig{? TM [{141>1. .TWAT :1:. ti'di?(ib.lni 4.. Pi CIA; .TA . • -
,, ,
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UnderCover Tent & Party, Inc.
' 35 LONGFELLOW DRIVE, CENTERVILLE, MA 02632 •
(508)778-2777• (800) 439-TENT
RENTAL UUUJ[t
Order Date: , ,8/02/93 - " Contract, No. :.' 12999 '.
Delivery bate : 8/25/93 '• Customer ID: 3941211 ,
Pick-up Date: one Number/` 3508-394-1211
tf Alt . Number 6-1 GG 7
Rented to: Del iver1fd Y 7�1
Paul Franchi '
Baynes Electric Supply 42 Commonwealth .
42 Commonwealth f !
Ave"'y - /�f
S . Yarmouth , 211•11's�T F s
Yarmouth , MFS "0266 ` /. ,tf. //' La
7:st Orr rlets:e 1-1-
Remarks: -- •
s��a
Please sign rental ag eernt return white cgpt6 a,+. plion9 hth 5 c/
your deposit 'ft•Ttiankfrow..ifee, ordeer ! JJ • cc ;
67, JzP iZS Li :i7
Unit . Disc . ! ,txtended
rt
DescriPt Quantity , Cost % Discoun Cost
40X60 POLE TENT Y/,/,W,y. t 1 800 .00 0 .00 0 .0• 800 .00
ah -....44-
Sub-total / 800 .00
Delivery Charge 0 .00
Tax 40 .00 `
Total Quote4'i a J v , `` 840 .00
T �'! �%!„
Deposits 75 .00
.r Al.!!! 4 0.•-r�!At t
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White-Office Yellow-Customer Lessee Signature X
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