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Home My WebLink AboutBLD-93-644 - - ..--cit•YAit of clarJy `k'� TOWN OF YARMOUTH 0 mi MATTACH[ 5 441 eCl o• / Application for a Permit to Build No. �' fir UPON FINAL APPROVAL 4- - 1INAP 31 L M-/? FEE MUST ACCOMPANY THIS APPLICATION. ` " " DATE 19 93 The undersigned hereby applies for a permit to build ?-3193 according to the following'specifcations i ` ' -- ' ' `- • •:' ✓, f Li!Name of property owner �grv/fe ec LrS#,. i✓ff-/7-.9) Tel...W-2,iir Address °RV S. 2 f,1.✓is /Pci, S. 5-,&,n#u'TN 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. instruction address Ar-So. y,enc #W ,21 g S.. DAski s . Flood District 8. Date of subdivision Approval plain zone C Zone R yo 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE �r .5 11-7 p t Type of room No. 10. Multi family 0 Y 'co • a° I 11. Commercial 0 Jd /'' 1 • 7 /- Kitchep 12. Other ❑ v ��y Dining Rm. 13. No. of stories U,� a0 Living Rm. Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath 15. Materials — Wood 0 Cement 0 Other 0 Deck 16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 ❑ 2 ❑ Family Rm. Sun room 16. Swimming pool - Size Garage 19. Storage shed — Size Shed 20. Stove — Wood 0 Coal ❑ 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 SignatureYd/e•s %•,*-fid IP-4-,L--2-- PLANNING BOARD Address Date `;,k n . . _ TOWN OF YAMOUTH . BUILDING DEPARTMENT HOMEOWNER LICENSE • ml TION • PLEASE PRINT: DATE r/ /19 3 JOB LOCATION iv S. �7 4ts . ,Q,L NUMBER STREET ADDRESS SECTION OF;TOWN "HOMEOWNER" /a,ect C'5&d (tear 39 Zane . NAME , HOME PHONE • WORK PHONE . . . PRESENT MAILING ADRESS C�j� . % • • •• • • ./ i . . CITY OR TOWN r. r, :"r'<.'.,y;; •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 1•1110 DOES NOT POSSESS A'LICENSE, PROVIDED THAT THE OWNER ACTS AS SUPERVISOR. (STATE BUILDING CODE SECTION 109.1.1) ,/ . . . . . . . .r , : , DEFINITION OF HOMEOWNER: PERSON(S) W110 OWNS A PARCEL OF LAND ON WHICH HE/SHE RESIDES OR INTENDS TO RE- SIDE, ON WHIICH 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 FOIM 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" CERTIFIES THAT IIE/SHE UNDERSTANDS THE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND THAT RE/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 Iia ilihy insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked ves, pleaseindicatethe type coverage by checking the appropriate box. A liability Insurance policy (5• Other type cf indemnity 0 Bend 0 OWNER'S INSURANCE WAIVER: I am aware- that the licensee does het have the insurance coverage required by hap'- 142 cf the F •ss. G I Laws, and that my signature cn this permitapplication waives this requirement. • Check ne: Owner Agent 0 Jgr1a:ue et Onrer Cf • er s A-,ent __ , .----- - .•- - • Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only NAME OF CITY/TOWN Permit No. Date Al l•1DAVIT Home Improvement Contactor Law Supplement to Permit Application MGL c.142A requires that the"reconstruction,alteration.renovation,repair,moderniziiion,conversion;improvement,removal.demolition. or construction of an addition to any preexisting owner-occupied building containing at least one but not more than four dwelling units....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: ,s//t qG Ae'4e t R 'oiC SOA/6 S at. cost Address of Work 29 S.. le,,J.ac ,e . _. Mote etini Owner Name: �AZ�niJCE_ lrt 9.t�3hre9n! Date of Permit Application: 8'/2-3/93 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law _Job under 51,000 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. I42A. 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 above ice, I hereby ap , for a r ' as the owner of the above property: 4 Da c Owner Name • COMMONWEALTH OF MASSACHUSETTS --=off,'. • DEIARTMEIvTOFINDUSTRIAL ACCIDENTS 600 WASHINGTON STREET • • JamesCamope,, • BOSTON, MASSACHUSETTS 02111 . Cpmm:ssone: WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • 1, 3te/4-1 QN 6. r/ifr,'d 0 (licensee/perminee) with a principal place of business/residence an f3 / gi' f3Y /fig . yr • (City/State/Zip) do hereby certify, under_the-pains and penalties of perjur c.thai: ;. ['/ 1 am an employer providing the•following c=Lorkers'compensation coverage for mycmployees working on this job. , • ' C • f ilnart" ./1/I Cfr V4 / . .. ; •4 . ('tiC I - 3 /2-. - 1 c74-09/ `0 /1 Insurance Company i ! 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: - . • .i . . Name of Contractor Insurance Company/Policy Number.. • • Name of Contractor - • Insurance Company/Policy Number - • Name of Contractor Insurance Company/Policy Number _ Q 1 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(CL 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 lecure coverage as required under Section 25A'of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to 31500.00 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 b'/c2y//r9 , 19 • Licensee/Permar:et” �'! LicensoriPtrmiror