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HomeMy WebLinkAboutBLD-93-641 O k F'YA c r//9o92 . -. %$s, vr- 'o . TOWN OF YARMOUTH MTTAOM[ 5 e,,A .M.,�.,e.5.0 Appliccation for a Permit to Build No. 64/ UPON FINAL APPROVAL $,a -`)/3 MAP /3 LOT 3730 FEE MUST ACCOMPANY THIS APPLICATION. DATE ..3 19/ The undersigned hereby applies for a permit to build T a according to the following specifications� Z/a4/93 • �. Name of property owner /t! v C ,9. 7110//h Tel. '775-^0790 Address .SA /-Snudeo ty I 4I. 94en'aIn14/4j,/ 2.Name of Architect(if any) / / Tel. 3. Name of builder en.0ml W Address 4. License No. Tel. 5. Name of Mason Address 6. cense Na. Tel. . Construction address 5:0 Ero JGuz4) tilt/ FlooDistag-- a� 8. Date of subdivision Approval plain zone Zone 9. Private dwelling 0 ___,Estimated Cost 0409,45 DO NOT WRITE IN THIS SPACE ,76• crD D adze Type .f room No. 10. Multi family 0 Zrrnp / Mr 11. Commercial : °/ �/ Kitchen 12. Other A / 3 '� Dining Rm. 13. No. of stories ihio/q3 35-,0-0 Living Rm. Bed Rm. 14. Foundation — Full 0 Half 0 Slab 0 �_W t-- e�r Bath 15. Materials — Wood 0 Cement 0 Other 0 c, da if/ • Deck 16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 0 2 0 Sro Rm. Suunn room 18. Swimming pool - Size Garage 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 ,. • From rear lot line Side line 25. HI.C.R. No. LOT RELEASED BY Signatul p PLANNING BOARD Address insUrDachceuy Date 49. Varn nd4 Ala PPLICANT: k yre 6C- //Ob/h BUILDING PERMIT is ADDRESS: SOI pGd / .&ay C.-0cy, TELE. NO. : 775--07yd DATE FILED: 3/45/417 BLDG. SITE LOCATION: Su. L• NAP/I: / t LOTII: S/ 3d 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. TEE 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 P I DATE: g//7 /Q•? N/A: INDUSTRIAL AN4I.R •SMMERCIAL PERMITSp� !/</`2d 5. WIRING INSPECTOR: _95477,79;i6DATE: vlirl7/ N/A: G. PLUMBING INSPECTOI DATE: N/A: 7. FIRE DEPARTMENT: ,.j�� d '/J ,?Q�_a DATE: fj/V4t5 N/A: r 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: • • BLM/89 TOWN OF YAMOUTH BUILDING DEPARTMENT „ -HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE F/rO7 JOB LOCATION 57, Aj[rvaoitua J Ze., /�feln,O4,s ,NUMBER STREET DRESS SECT OF_TOWN "HOMEOWNER" 4' 744'7V1 ,4o✓/(., 7 7 c-D 79 o WAKE _.. HOME PHONE L� WORK PHONE • - PRESENT MAILING ADRESS C/o � O• gex 7 g-/" 62‘77 GG�y C ' �/✓Tj ,4n CITY OR TOWN STATE 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 W110 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/SITE 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 WHO CONSTRUCTS MORE THAN ONE HOME IN A TWO-YEAR PERIOD SHALL NOT BE CONSIDERED A HOMEOWNER. SUCH "HOMEOWNER" SHALL SUBMIT TO THE BUILDING OFFICLIL, 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) TILE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH THE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGULATIONS. THE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS TILE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE ' WILL COMPLY WITH SAID PROCEDURES AND REQUIREMENTS. HOMEOWNER'S SIGNATURE 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 COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you haveits,4ked please indicate the type coverage by checking the appropriate box. A liability Insurance policy 0 Other type of indemnity 0 Ecnd• ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 cf the Mass. General Laws, and that all signature on this permit application waives this requirement. • pck one: Owner Agent 0 Siynar ct O*r.er cr Dearer s Arent __ _____ tCOMMONWEALTH OF MASSACHUSETTS --__ • DEPARTMENT MENT OF INDUSTRIAL ACCIDENTS ce 600 WASHINGTON STREET • James J Camooe: BOSTON, MASSACHUSETTS 02111 • Comm,ssionet WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • I. /14y/-//c f7= 4onh (licensee/perminee) • with a principal place of n /business/residdence a co Xroadeca.y1 t ect rzi-m10,11 ,4)9 O2e77 (Ciry/Stare/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 - lj/ 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 impoiition 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. Signed this / 4.7:4 day of 67l.Crlif , 19 y el % %/i_.,r.� Liccasee.' ermine: LicensoriPermirtor PLOT PLAN • /g/5/.30 FOR LOT # • Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) ® , • . Well g I (lot ft. rear) Abuttor's I Abutto Name I Name Lot # - I r Lot # REAR YARD •Z'�12L1) If this is a Ifth' corner lot, 1 ft. corner write in name • write of street. name I a - other 0 street m rti 4 • SIDE YARD SIDE YARD • HOUSE • (-i FT. 0 • a FTQ • • 4 ` • • � N o% I1 • • SET BA K • • • • (lot ft. frontage) ' \ / \ / \ / (NAME OF STREET) . > E • . . . / \\ •Information ‘2,..0'„,, ,27g17i// / \ Supplied by r �-�- i t 'Gra' f Ills V 1 I . '� " i `Y i V 5 'i; 'tiePITH' i, I i V V V I V ' ? V.;Y .' �>v. (l� Li �iil�ili t}tt1. .la(l (tt it 1: i 1'91 1 El 1 1 tl 111 1 1, 1 cl 1 1 L 1 1 1 1 1 t' t l f . Certific" ate of _Paine At‘ e'siztatirre _ REGISiURED ISSUED 6Y Dots trvatad of AFFIXATIONAcademy Tent & Canvas manufactured �r 2910 S. Alameda Street i �` Los Angeles, CA 90058 6/30/92 - n� F-337 g rs •' r I (213) 234-4060 This is to certify that the materials described on the reverse ride hereof have been flame- re retardant treated CA E ro Inohsrrtnfly nonflammable).RFSS 5 COLONEL DR T V F UNE STATE CA 02532 ►, cant Codification is hereby made fhafs (Check "d' or "b") IA (a) The articles described on the reverse side of this Certificate have been treated with a flame-retardant 6®d chemical approved and reclstered by the State Fire Marshal and that the application of said chemical was done in conformance with the laws of the.State of California and the Rules and Regulations of the State Fire Marshal.. __ 3 Nams • of chemical used.......w ...Chem. Reg. Nr'- ~ . VMethod of application -�.... - --� " """- © (b) The articles and gibed on the re the Stat i Fire Marshal are fo made tfh use.rom a flame-resistant fabric or material. y Trade name of flame-resistant fabric or material used...............a. Vinyl „Reg.No...-F-337_ , The Flame Retardant Process Used .f it Not Be Removed by Washing 74 itillicti not g David Bradley B Tom Shapiro - President Name of APP .tor or Production Superintendent y Title _ iWISPA tilbiliginlitRii►•tiRigixtUAitilitiitU'tPPLIMIAPAPiitli7tiiWW igliiPtiMiMiuiMPgTl T&P Wtil WWTAPU) r•• - • *** PLEASE NOTE, YOU MAY NEED THIS CERTIFICATE TO BE ISSUED A PERMIT FOR YOUR TENT. PLEASE CHECK WITH THE BUIEDING INSPECTOR AT YOUR ' TOWN HALL. *** : t • • 71 • • Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only - •• • .'NAME OF CITY/TOWN t remit No. - - • Date AFFIDAVIT • • Home Improvement Contractor Law Supplement to Permit Application mut.142A requires that the"reconstruct ion.a It em t ion.renovation.renai r.modernization.conversion.i nprovemen t.removal.demolition. or construction of an addition to any pre-misting owner-occunied building containing at least one but not more than tourduelling units....or to structures which are adjacent to such residence or building"be done by registered contractors,with cenain'exceptions,along with other requirements. Type of Work: /CN-.�a c, /c-Ar Est. Cost�St.. ,a Address of Work Co Rye)cIts a, c, ye.--v-s,i ,,/C Owner Name: y vile 71i- /�'j a/✓vim Date of Permit Application: •jjn //3 I hereby certify that: . • Registration is not required for the following rcason(s): • _Work excluded by law _Job under 51,000 _Bu' ing not owner-occupied wncr 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 1.32A. 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 abov% notice. I hereby apply for a permit as the owner of the above property: n �g 3 (Ni//iF1r h� �/cv( (�v i p%%`/ /f/"/6vii, Date O„ner Name