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Home My WebLink AboutBLD-93-639 itA �' To . TOWN OF YARMOUTH �l��p��'s� '• MATTAGM[[5 ' - 'e lfi Application for a Permit to Build Na- bL .:_. UPON FINAL APPROVAL �� -93 MAP LOT FEE MUST ACCOMPANY THIS APPLICATION. DATE c------1 The undersigned hereby applies for a permit to build 7/p�J�0-3 according to the following specifications GG��3 1. Name of property owner F62�/'I"el. Address 2.Name of Architect(if any) - Tel. 3. Name of builder Address 4. License No. Tel. 5. Name of Mason Address 6. License No. Tel. 7. Construction address Flood District 8. Date of subdivision Approval plain zone Zone - - 9. Private dwellinge _ Estimated Cost L-LuP' DO NOT WRITE IN THIS SPACE 10. Multi family 0 $'rtft L/1/4 o De Type of room No. D 11. Commercial 0 % • - .' hofs,(; k Kitchen 12. Other r�, CZ ! o -T-Dining Rm . 13. No. of stories /--X/ 9e'/ - - Living Rm. Bed 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 y fi --5; er- Ba hRm. 15. Materials — Wood 0 Cement 0 Other 0 ,bee 35'700 Deck /a-)(j[t' I - 16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 `—et; 70 •0v- Closed porch 17. Garage — 1 0 2 ❑ '7 .�-a 9a-? Family RI*,/„-;,_ i , Sun room 18. Swimming pool - Size _ , ., ra � r�,, �$ e g 19. Storage shed — Size „' - -, Jodi Shed 20. Stove — Wood 0 Coal 0 - ' 17 -;: `,Arl •- , 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 PLANNING BOARD Address Date APPLIC4NT: BUILDING PERMIT i': 6 p 9 ADDRESS: TELE. NO. : DATE FILED: • BLDG. SITE LOCATION: MAPi: LOT/I: 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 COPPIERCIAL 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 REQUIREMCNTS 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 DATE: 9- y_ q F, N/A: • IND TRI AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: • G. PLUMBING INSPECTOR: DATE: 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: Ca n Q4�G. SI n1 .T Rr9w tetfrrr as 2 iaiue of 4 " 577aDFA4 S(1°Ofl EA.uN(„ R- 14 BLM/89 TOWN OF YARMOUTH • - •- BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: . - . . JOB LOCATION: . NUMBER • . . . STREET • . . VILLAGE OWNER OF PROPERTY: - • • CONSTRUCTION SUPERVISOR: ' NAME LICENSE NO. PHONE NO. , . ADDRESS: . , LICENSED DESIGNEE: . (IF OTHER.THAN SUPERVISOR) NAME LICENSE N0. 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 LICENSING CCI- STRUCTION SUPERVISORS IN ACCORDANCE ,KITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTANI 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 MGLth.152 Yes ❑ ' . No ❑ • If you have checked v_s, please indicate the type c:verage by checking the ap;rcpriate box. A liability insurance pc.icy 0 Other type of :idemnity 0 Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee dcei rot have the insurance coverage required t:y Chapter152 of the Mass. General Laws, ana that my signature on ta:s permit application waives this requirement . Check one: • Owner) Agent 0 • Signature ot Cl`ner or Owners Agent ' SIGNATURE: BUILDING OFFICIAL APPROVAL: ti Suggested Affidavit for Home Improvement Contractor Permit Application For Omce Use Only NAME OF C1TY/I'OWN Permit No. Date AFFIDAVIT Home Improvement Contractor Law • Supplement to Permit Application MGL e.142A requires that the"reconstruction.alteration,renovation.repair.modernization,conversion,inprovemen I.removal,demolition. or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than.four dwelling umts....or to structures which are adjacent to such residence or building"be done by registered contractors.with certain exceptions,along with other requirements. Type of Work: Est. Cost Address of Work • Owner Name: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): • _Work excluded by law _Job under 31,000 _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 c. 142A. - Siencd 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 notice, I hereby apply for a permit as the owner of the above property: Date Owner Name p, _ COMMONWEALTH OF MASSACHUSETTS • t.‘a_2 r • DEPARTMENT OF INDUSTRIAL ACCIDENTS • Vcc" • 600 WASHINGTON STREET • James Camooeu BOSTON, MASSACHUSETTS 02111 • �ommss oner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • I, • (l i cera see/permittee) • with a principal place of business/residence at: (City/Sum/Zip) do hereby certify, under the pains and penalties of perjury, that: [] I am an employer providing the following workers' compensation coverage for my employees working on this job. • Insurance Company Policy Number [ ) I 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 • • • 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 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 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 S1500.00 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. Signed this day of , 19 Licer.set/Perini ec Licensor/Permiztor FOR LOT Indicate lncaticn cf garage or accessory building • Additions with dashed lines • Sewerage disposal (cesspool) e well 0 Oct ft. rear) fi $` 4buttor's I ' Abutter's vame _ Name Lot # \S1 Lot # REAR a°D :f this is ai' If this i zsner let, J. .....1.. ft. carne_- lc' a to in name r � write in )4f street. 1,�1 I name of • I . ether u �; CI s=eer. I • SIDE YARD SIDE YAR MCCSE =-' • p - -- - - -� r • Q SET BACK • o � c (rt f`. frontage) \ / \ / \ / (NAME OF STREET) \ / • \ , wu r�a.r pi V L H p( m Na.c. a)(oPT JOiST5- I Vac_ - - ID ' 4PH Pr (9: ----- it "53 Afr.:7-0 h j, ---D_c_- (k , i I Pk& , V S/1-3 a- �\ / �o ' R3d 3 41 J(4ro� i ,. . ., ...:_re.„ , ,i,„,,,t, -#7. Ae.,„ ; !.4i4 'i.� ,,b , lGYg..J . � ti 4 � 4eel —_____ X(„ % no157 teN�act �fasSscca' . I Fl��d� v n�10�t coxltr�j}=• -3YtoJV 5 • -t - [ : �411j�lceilim CEILING ASSEMBLY to cls PCI[FaL TOTAL R= s011P TOP SURFACE 11= WINDOWS: R=0.61 FEJHRD mL L= 30.0 9" FIBERGLASS Lk 0,033 il�/ ' . 7 RI=30 SULATION -_-(.`C._. c\ ()Il II/MAMA To n n di \=SIlEETROCK DOORS : a./ 1110 R= 0.45 _ 1 0 —BOTTOM SURFACE R= 0.61 1/2"'PLYWOOD INSIDE SURFACE ' WALL ASSEMBLY ' REAR R= .0.62 � 1 R= 0.68 PCILAL TOTAL R= ELEVATION WOOD A _ G.W.A. SOIDGLES �/ I }'!'SBEETROCR . U R= 0.87 I R= 0.45 FEWE D 1DTL Fb 12.5 WINDOWS: Li 0.08 OUTSIDE 31" FIBERGLASS ;y KHF SURFACE i INSULATION ESC MT Lk 0.05 7 R= 0.17 =SURFACE RESISTANCE ' ,�/' 0.1 ' R= 0.61 2 FLOOR ASSE`BL2 J I ,•.,Fa- : FLOOR PCILFI TOTAL R= DOORS: TWO BEADS C R= 0.91 U= CAULKING / '1 L FIS R717�C Lb 20.0 A i/ i PLYWOOD Lb 0.05 UNDER PLATE A �� i SUBFLOOR RICHT SIDE ELEVATI R= 0.62 �� OUTBID G.W.A. SURFACE 1 H '' V L. Jo./ , t /V C'C-'UO1 R= 0.17 ( / WINDOWS: //-6}" FIBERGLASS .� ' I INSULATION FOUNDATION ONCRETE R= 19 WALL ASSEMBLY OUNDATION ; � (may be used instead DOORS: ALL SURFACE RESISTANCE I 1 32 = 8" R= 0.61 of floor insulation) �. / _ PCRYL TOTAL R= LEFT SIDE ELEVATIG. 1.48 = 10". U= /� 1- i LBZIII�D ^'7�L R 25 G.W.A. �li INSIDE SURFACE Lk 7.08 L —F= 0.68 '/8" SH..r MOCK WINDOWS: I. ' ,Z----i= 0.32 • '" STYROFOAM . t ' /�= 7.1 I DOORS: OTES: PE=u\NEirI I: INSTALL= .STC Y. WI:. .0W.. TO ..E USE. ':CC�3 WALL AREA= ^ Og.- ,/ WI: _ W '.RF_.= 1 qO 194 : (:::: ....:_,- J