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$� SR. TOWN OF YARMOUTH o r,r g�yn3
,," il0 Application for a Permit to Built) No. 1 '`/3 )1,3
UPON FINAL APPROVAL /J 91- - 'MAP✓ /o3 LOT" y37
FEE MUST ACCOMPANY THIS APPLICATION. DATE C7C--0� 1973
The undersigned hereby applies for a permit to build �,
according to the following specifications 1 t f ll��/ 2-6 y
1. Name of property owner Les t-kaAL IPP.ti 41 Tel.
Address Ca t-, t- otoLo jsA D YET' 394' 3070 Wk.
2.Name of Architect(if any) Tel.
3. Name of builder Tina_ E• -dor Weed P baucii Address MO &t. ktsf, SDE
4. License No. Tel. 760-YSoo
5. Name of Mason — Address
6. License No. Tel.
7. Construction address loo CI C('f (n11 e II b r y f- T- •
Flood District �,�C
8. Date of subdivision Approval plain zone e_ Zone
9. Private dwelling 0 Estimated Cost `i ?tg lo. 0D N-OT WRITE IN THIS SPACE
•
10. Multi family 0 100'00 _
Rao.o s pa ,A-P Type of room No.
11. Commercial 0 g X Kitchen
12. Other ❑ She-- Dining Rm.
13. No. of stories 0.14.. a--c) Living Rm.
•
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 /o , o-v.17t7 Bed Rm.
--
Bath
15. Materials — Wood 2"fement 0 Other 0 q / 0 . n 8 Deck
16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch
17. Garage — 1 ❑ 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size Garage
✓19. Storage shed — Size 8 w2 "' `Shed 9y i Z i
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 It- No. of feet side 8 No. of feet rear /L
/23. Distance from nearest building: Front Ft. side Ft. side Rear
24. Distance back from line or street From rear lot line �7L 11 Side line
25.O E. No. .� (�
LOT RELEASED BY Signature
PLANNING BOARD Address 66 4-*rnt,1 nA lia
Date VPT1 OA Pt- or16 7-5
�zoi7,5 flEs
/� BUILDING PERMIT APPLICATION SIGN OFF
1
APPLICANT: .ESi t A L(--6.-,V BUILDING PERMIT //:
ADDRESS: (, [, .Q-ctatio -( � '(L, TELE. NO. : 3&7.fQQ DATE FILED:
BLDG. SITE LOCATION:(,(Q ,AQLouJ(... epro NC- , Y :17MAP#: /03 LOT//: Y3?
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: •
bETERMINES 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. CONSERVATION: DATE: N/A:
4. HEALTH DEPARTMENT DATE: N/A:
INDUSTRIAL 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 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. p
COMMENTS: Sc�1 I Lo i PAs) '
•
•
BIM/89 .,
TOWN OF YAMOUTII
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE `i f i ( `i 3
JOB LOCATION (4(.o - i)Itty e I Pir ;NtUVCn f EMS-`- C
NUMBER STREET ADDRESS SECTION
(OF:TOWN
"HOMEOWNER" �STe-fL & ) �j(o2-'(C1�7 Oc 3 y 't—`3d c a
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADRESS to(o P k4e-ro
CITY TOWN STATE C
2i alOt&'CODEZIP
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-
DLVIDUAL FOR HIRE WHO 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 WHO 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 FOILM 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
BUILD INC CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGULATIONS.
THE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH
BUILDING DEPARTMENT MINIMUM It(SPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE
WILL COMPLY WITH SAID PROCEDURES AND REQQUUIREMENTS.
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 0 No El----
If you have checked ves, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy 0 Other type of indemnity 0 Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
/� Check one:
l ye- Owner p— Agent 0
. Signature of Owrer cr Owner s Agent
/PLOTT PLAN
FOR LOTM/ `�� �` 3q
•
Indicate location cf garage or accessory building •
Additions with dashed lines
Sewerage disposal (cesspool) 49
Well p
I (lot • ft. rear) I
kbuttor's • I y I -- - } • • w;j 's
lame t).( Name
Lot # 40 � Lot 11)/
V40
REAR YARD --
:f this is a �o t_ If this i_
=mar lot, 30 ft. corner lo
write in name write in
)f street. .` ,. i name of
21
c I : other
0a sweet.
C) '-,
SIDE YARD YAR:
9
HOUSE zN, 5S
• 4,o'
4 • •
a
SET BACK
TS..
o I
I
1 C
(lc` ft. frontage)
\ / (0 1 firmAker-pi L\-11a VR
\ /
/ \ / (NAME OF STREET)
\ <
CEJ///�//l aa
Suggested Affidavit for Home Improvement Contractor Permit Application
For Office Use Only NAME OF CITY/TOWN
Permit No. .,
Date
AFFIDAVIT •
Home Improvement Contractor Law
Supplement to Permit Application
MGL o.142A requires that the"reconstruction,alteration,renovation.renair•modernization.conversion.inprovement.removal.demolition.
or construction of an addition to any pre-exisiing owner-occupied building containing at least one but not more than four dwelling units....or •
to structures which arc adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: 8 xfZ S(. i Est. Cost WOO
Address of Work / (c A.r -ocoLacfr De y AAA
Owner Name: LZ -c..-- A\kC,, art.
Date of Permit Application: 97419') -
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law
Job ndcr S1,000
ilding 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.
Siened 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:
tS2o/Q
DaOwner Name
•
7• Application to 3 9 6
a •. ""''�;.- -...+ Old King's Highway Regional Historic District Committee
In the Town of Yarmouth for a
CERTIFICATE OF APPROPRIATENESS
r,
Application is hereby made in triplicate,forthe issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,
Acts and Resolves of Massachusetts,1973,for proposed work as described below and on pigs,drawings or photographs
accompanying this application for: io 8
CHECK CATEGORIES THAT APPLY: nx Rf '
1. Exterior Building Construction: ❑New Building ❑Addition O Alteration =r'
pit• TI
Indicate type of building:❑House 0 Garage 0 Commercial 0 Other R < P
2. Exterior Painting: 0 —T W
7,-7P
3. Signs or Billboards:0 New sign 0 Existing sign 0 Repainting existing sign Di , "Cr
r
4. Structure: ❑Fence 0 Wall 0 Flagpole 'Other 5t't g .
• . ,. '
,.;. Z.
(Please read other side for explanation and requirements).;
TYPE OR PRINT LEGIBLY -DATE ..1 12-2_' R 3 .
ADDRESS OF PROPOSED WORK L{p TC'&CDIA14EA-0 bc.i%at., \TI.POIrrASSESSORS MAP NO. ICI
OWNER l.-L‘—re-c- 44 Ate\ ASSESSORS LOT NO. V 3c)
HOMEADDRESS 4(o Alf $(-64-0-4 6-A-1 (QC-. 1 'iA1.-Inr9a"ft#PAC- -I. TEL. NO. 394-3°9•0
•
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public
street or way.(Attach additional sheet if necessary).
a*..O'brtaw CS /4rcrowkra .4 DR- `M.- ) M A OZ-Co2S
'1)0.4-‘a ph.kltpr ' in ' Net-I-pooV. &t ' VET- frt A oz.c--
010•Avy ColuJ/n 73 514.-e-b%ol-. tic /� jr, PA Pr dZCo'�S"
AGENT OR CONTRACTOR Q011/2-:::Ce — /-f2<_F1,-) TEL. NO. LI--3041n
ADDRESS SR-Mr Vac's eriaiNJ Gs
DETAILED DESCRIPTION OF PROPOSED WORK:Give all particulars of work to be done(see No.8,other side),including
materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and
proposed locations of new signs. (Attach additional sheet, If necessary).
I' x ILc ?tut Er>a-Cb -root— st-+e 1 € e- Pte..-at_ *too 7.....J�)�c c ' fNbJU
+
1I4 F2r -- $ x
oac SAc - oSTc;LC, `�. LC-C -CL,
i . , Signed
• Owner-Contractor-Agent
Space below line for Committee use. .
Received by H.D.C.
Date i'e-a,14!) The Certificate ishereby i• .(l Date - I1 ^ ~1 '
V - /f -L
Approvedic IMPORTANT: If Certificate is approved,approval is subject to the 10 day a@PC�I�ttrfod
EE
provided in the Act. 11 APPROVED���
Disapproved ❑ Please return to: Yarmouth Historic District Committee YARM.DUiH CDMM,ITT
Town Hall, 1146 Rt.28,South Yarmouth, Mass.02664 OKHRD
4.
ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATION •
FOR A CERTIFICATE OF APPROPRIATENESS
h� of C
The four categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a
separate form). -)
•:_
•1 ter
1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a
building to be erected or altered including windows,doors,siding,roof,light etc.,that will be visible from any public street,
way or public placeyThe following scale drawings are required in duplicate with application: plot plan (if addition-show •
existing buildings in outlinee),floor plan and elevations.Also required are snap shots of existing buildings,where additinns or
alterations are to be made.No plot plan is required for addition or alteration which does not touch the grow,�.
.� •
2.EXTERIORPAINTING:Anapplicationisrequiredforanyportionofabuilding,structureorsigntobepaintedL;lath ,ible
from a public street,way or public place.Color samples must be attached to these applications.An application Is not ren ,fired
when repainting existing colors,changing to white,or using colors approved by the Town Historic Dir' .nmit, :.
3.SIGNS OR BILLBOARDS:An application is required for any sign or billboard to be erected within the District,v..,,i the
following exceptions:
a. Existing signs or billboards on November 27, 1974 shall have until November 27, 1977 to secure an approved
Certificate of Appropriateness. ,t
b. Temporary signs for use in connection with any official celebration or parade or any charitable driver ring Ps they
are removed within three days of the event.Certain temporary signs that the Committee feels does not deli', ,om
the Act may be allowed with the prior permission of the Committee.
c. Real Estate signs of not mor: than 3 square feet in area advertising the sale or rental of the premises on which they
are erected or displayed.
d. A single sign of not more than Isquarefootinareashowingthename,occupationoraddiessoftheoccupantofthe
premises on which they are erected or displayed in a residential zone.
4.STRUCTURE:An application is required to build or alter any structure within the District which is defined by the ALL as a
combination of materials other than a tuilding,sign or billboard,but including stone walls,flagpoles,hedges,gates,fences,
etc.
GENERAL REQUIREMENTS
5.Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the
Town Clerk by the Committee.Approval is subject to the 10 day appeal period provided in the Act.
6.No changes shall be made from the original approved specifications without advance approval of the Com- ,sion r n an
amended application filed with the Committee.
7.A separate application must be filed with each project requiring a Certificate of Appropriateness. '
8. Under heading of "Detailed Descripi on of Proposed Work" give detailed data on such architectural featunn. as:
foundation,chimney,siding,roofing,roof pitch,sash and doors,window and door frames,trim,gutters-leaders,roofing and
paint color.
9.Unless application Is complete and legible and all material required is supplied,application will not be accepted or acted
upon.
Copies of the Act establishing the Regional Historic District may be obtained at the Town Hall.
1
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PLOT PLAN
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.
/°0 39 39 0 ?
i� "`FGR LOT n
Irdic`ate-.-I atcn cf garage er accessory building
�A-dditions with dashed lines )
Kt rdbnosal' (cesspool) el • 9�/`OROVED
Well • YARMOUTH COMMITTEE
193 1'Ai13., PZ,I/Z - OKHRD
•
!TOWN or YAPHLUit (lot • • ft. rear) I
?Obi CLERK iREA:a it f; — — — —
4buttor's I Abuttor';
\tame IName
Lot fi '- Lot R
REAR YARD
:f this is a 5`.�Ck ... If this i
orner let, 30 ft. -- corner 1
**trite in name . :. - write i..-
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3902
3R' o 7
OLD KING'S HIGHWAY'
JHISTORIC DISTRICT COMMITTER
FOUNDATION: concrete block � ,
fl `zAPPROVED C-
Y RMOUTH COMMITTEE
SIDING TYPE: Pine Boards COLOR: OKHRD
CHIMNEY: COLOR:
ROOF MATERIAL: asphalt shingles•. PITCH: • COLOR:Weathered wood
WINDOWS:RIVCO double hung w/snap out grilles SIZE: 12/12
TRIM COLOR: Natural
DOORS: pine COLOR: Natural
0
SHUTTERS: None COLOR:Z o W
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GUTTERS: None • COLORS
m? 'D \ <
DECK: None SIZE: COLOR` rr ITJ
it;
GARAGE DOORS: COLOR:
STORM WINDOWS & DOORS: COLOR:
SKYLIGHTS: SIZE:
FLAT ONLY APPROVED)
OUTDOOR LIGHTING: TYPE (SHOW WHERE) NUMBER & WATTAGE:
(FLOODLIGHTS NOT APPROVED ON FRONT OF HOMES IN RESIDENTIAL AREAS)
*METAL BUILDINGS NOT APPROVED IN NON-INDUSTRIAL/COMMERCIAL AREAS*
THREE COPIES OF THIS FORM MUST BE SUBMITTED ALONG WITH THE
APPLICATION.
FILL OUT COMPLETELY REGARDING MATERIALS, MEASURMENTS & COLORS.
ELECTRIC METER LOCATION:
LANDSCAPING: None
3C107
OLD KING'S HIGHWAY`
HISTORIC DISTRICT COMMITTEE{
FOUNDATION: concrete block 6/H! PROVED O—
YARMOUTH COMMITTEE
SIDING TYPE: Pine Boards COLOR: OKHRD
CHIMNEY: , COLOR:
I
1.• r.y
ROOF MATERIAL: asphalt shinglea*VPItSH: ��• :COLOM Weathered wood
WINDOWS:RIVCO double hung w/snap out grilles SIZE: 12/12
TRIM COLOR: Natural
DOORS: pine . . n- COLOR: Natural
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SHUTTERS: None COLOR: '
0
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GUTTERS: None -*• °"" COLag
r;lq
DECK: None SIZE: COLCrE w (+ ELj ,
ms
cg t\3 r
GARAGE DOORS: COLQW: 11 a
H
STORM WINDOWS & DOORS: COLOR:
SKYLIGHTS: SIZE:
FLAT ONLY APPROVED)
OUTDOOR LIGHTING: TYPE (SHOW WHERE) NUMBER & WATTAGE:
(FLOODLIGHTS NOT APPROVED ON FRONT OF HOMES IN RESIDENTIAL AREAS)
*METAL BUILDINGS NOT APPROVED IN NON-INDUSTRIAL/COMMERCIAL AREAS*
THREE COPIES OF THIS FORM MUST BE SUBMITTED ALONG WITH THE
APPLICATION.
FILL OUT COMPLETELY REGARDING MATERIALS, MEASURMENTS & COLORS.
ELECTRIC METER LOCATION:
LANDSCAPING: Nonef
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