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Home My WebLink AboutBLD-93-648 `' TOWN' OF YARMOUTH cQc.( J 2f /9j targIc C(5�5 .:•.: i D K F ?Ito14i MAT 7,ct . 5 "� .,, 4.,5. .- Application for a Permit to Build No. (011-9) UPON FINAL APPROVAL %', (0- I A MAP ' 111- L i' " 1 • FEE MUSTACCOMPANYTHIS APPLICADION. ' -4,, , DATE Rao 1993 44 , ,. 1 (-�, .` « r __ 1 i y"'..-'', ; "'` ,:" , ni The undersigned hereby applies fora permit to buil ; • N 793 according to the following specifications \ v/ 7 . 1. Name of property owner /11,4 WESLEY lYiPA 1 RIchfA,¢ DSnn- Tel, 7•114-28 a •', Address 3« l nn' aA,b, "RA ,Srl Ya*ou r/H - 2.Name ofArchitect(if any) jut-Pt•-C Tel. 3. Name wofbuilder_ in. 73nohiv Address P 2;314.6.) bL. \C41 4. License No. 00 VOS O Tel. 77, — 7 , crD 5. Name of Mason /7e)."2 r Address 6. License No. Tel. 7. Construction address �C \3) ( e e i♦ - % A . Flood C-- Zone t - 8. Date of subdivision Approvalplain zone 9. Private dwelling 0 / Estimated got DO NOT WRITE IN THIS SPACE vv VP' �e�F'ue �o bhp. �ti'Type of room No. 10. Multi family 0 '02, Ude f, 11. Commercial 0 bee,K "i7'/ -- Kitchen 12. Other g1 Pe< K . Dining Rm. 13. No. of stories Living Rm. ij�—� Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 J Bath 15. Materials = Wood Els Cement 0 Other 0 '— /69 ' 00 Deck , „r' 16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 _rc An CClosed porch Family Rm. 17. Garage — 1 ❑ 2 ❑ Sun 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 ,or No. of feet rear 01) No.of feet deep '2 It 22. Size of building. No. of feet front SR No. of feet side 56 No. of feet rear 57 2a Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from line or street 93.- ' From rear lot line if 1 Side line as-10 25. H.I.C.R. No. 111-1166- . LOT RELEASED BY Signatur(j2- PLANNING BOARD Address 2 f�, ,b //' {yu lieu . Date Cie aIert Vit Ile_ WIct o? aG, ,T7 APPLICA T: �ji- fR1c,M456n/ BUILDING PERMIT ; : ADDRESS: :31h LNG POND Rb _TELE. NO. : ,Y-2 Fr DATE FILED: 7110 BLDG. SITE LOCATION: MAP/l: $ Z LOU: /04 THE FOLLOWING INFORMATION OUTLINES THE PROCEDURAL STEPS REQUIRED TO OBTAIN A PERMIT TO BUILD, ALTER, OR ADD TO A STRUCTURE WITHIA THE TOWN OF YARMOUTH. THE BUILDING DEPARTMENT WILL DETER- MINE COMPLIANCE TO THE FOLLOWING. +,'--.) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD PLAINS ZONING. THE BUILDING DEPART>IENT 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. THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN DIE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR ISSUING THE REQUIRED BUILDING PERMIT: REVIEWED BY: 1. WATER DEPARTMENT DATE: N/A: 2. ENGINEERING DEI' ' ENTI a DATE: N/A: 3. CONSERVATION: . 'MAnti DATE: pj - - N/A: 4. HEALTH DEPARTMENT ' fir/7/ DATE: /?.d Q N/A: IU,UST IAL 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: C• . . /r . .. i - . .c Q.ned OW Der fc 13- t , f 6-127-C • ELM/89 • •n.7149 o- negl / , 1 spot) =''C/-Oy sy "� Sit °i5 ' l,17/ 'NOdc BUILDING DEPARTMENT t ♦ CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: ' • JOB LOCATION: 3/C . le;/06 /Lb6 oAO , ' 42,470;1124— NUMBER �--� STREET VILLAGE OWNER OF PROPERTY: ' , s I/jL6y rJ j/(/G,trj{,CASato CONSTRUCTION SUPERVISOR: £ A L, ljttm. ,.;•i1 ' • 'OO '/eC •- 7) —7/50 • NAME �} LICENSE NO. PHONE NO. ADDRESS:' 9 7.,., ,` ct) t, ( ' • 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 COIv3LETELY 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 tEMOLITION flVOLVING 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 BE 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 DEPARTMENT. r I HAVE READ AND UNDERSTAND MY RESPONSIBTLITIES UNDER THE RULES AND REGULATIONS ,FOR :ICENSING CC: STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERST:C THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDIN OFFICIAL. INSURANCE COVERAGEi: I have a current liability insurance pclicy or its substantial equivalent which meets the requirements of MGLth.152 Yes V ' . No ❑ If you have checked v`s. please indicate the ;plc./erne by checking the ap_rcpriate bcx. A liability insurance pciicy K1 Other type cf :.idemnity 0 Bend 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee dces ret have the insurance coverage requires :;r Chapter 152 cf the Mass. General Laws. anc that my signature en this permit :-p:icaticn waives this requirerrent. y Check one: Owner:; Agent❑ Signature or Owner cr Owner s Agent J .,NATURE BUILDING OFFICIAL APPROVAL: Suggested Affidavit for Home Improvement Contractor Permit Application - -• - .- - - - - For Orrice Use only - NAME OF CITY/TOWN • Permit No. .. :-- ..- ( � PWIOU Hi' • _ - - Dote AFFIDAVIT •• Home Improvement Contractor Law Supplement to Permit Application MGLc.142A requires that the"reconstruction.alteration,renovation.renair.modernization.conversion.inprovement.removal,demolition. or construction clan addition to anv prcc\isiinto•.vncr-occunied huildinycontaininr!st 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 cenaint ceptions,along with other requirements. • Type of Work: ' tor, ,t c. o c�)i .e.1 Corn Es -e ct. CostenO0C) Address of Work 3 1 C Lak)c Vi1�- tt t D r Corn Y iy Owner Name: M►ts Wcsto,C/Ctq?,) PIcwiDson/ • Date of Permit Application: 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. 142A. • Signed under penalties of perjury: I hereby apply for a permit the agent of the owner: Dat (�jUo� ��t . //ya Fjo contractor Name Registration No. OR: • Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Nu PLOT PLAN .- FOR LOT n ` a A- j3 Indicate location cf garage or accessory building • Additions with dashed lines Sewerage disposal (cesspool) Well 0 • I1.-.,u GK5_ POND I (lot rl'l ft. rear) I 4buttor's I Abuttor's game IName Lot a Lot N REAR YARD f this is a 75 ��(11 If this boner lot, ft. corner it to in name write in Lf street. I name .of • IfY15270.1& I . ether u ri u s.=eet. u SIDE YARD SIDE YARD i NOOSE . __ 1 • ,%1 I f y4„ e % rib SET BACK ..?i1.ft. O d G. (Io" fa- frontage) • \ SNC. Po kb \ \ / (NAME OF STREET) ! i / . / \ L_ : - -a-a rejc R..A..... ...r.___ / \ c5 COMMONWEALTH OF MASSACHUSETTS • • DEPARTMIN'T OF INDUSTRIAL.ACCIDENTS • • • 600 WASHINGTON STREET James Camppet: BOSTON, MASSACHUSETTS 02111 . Comm,sstone WORKERS' COMPENSATION INSURANCE AFFIDAVIT • 1, Z-76112. L IoRtr&j4 (licenser/permittee) • with a principal place of business/residence ar 9 f�� V,c� ` )A2 (t41--6C1/1 11< (City/Sure/Zip) do hereby certify, under the pains and penalties of perjury, that: R.I am an employer providing the following workers' compensation coverage for my employees working on this job. • Insurance Company Policy Num&er [ ) I am a sole proprietor and have no one working for mc. ( Iam a scie tic:. reneral contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance politic: • 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. NOT:.Please be aware that while homeowners who erpioy persons to do maintenance.eoostruetion or repair work on a dweiiine of not core •than are: units in which the horcowncr also resides or on the grounds appurtenant thereto art not generally considered to be employers under the 'Workers' Corpc:sation Ar.(CL C. 152,sec 1(5)).application by a homeowner for a license or permit may evidence the ler..1 status of an employer under the Workers' Compensation Act. I understand that ; cony of:.his statement will be forwrded to the Cepa. —..en:of industrial Accidents'Office of in:Pr—cis: for coveraze vcnnc:::on anti that ::::rte :J S:Cu:e CDvertie as r[CLi C. under JC_Jn 25AofMGi. 15: can lead to en: imposition of criminal penalties ccns75Cng of : ane Os up :o 5'et‘'h 00 a d or i-priso----t or up to one yea'and Ct1 pena:tits in the form of :Stop. Tork Order and fine of 5100.00 : day against -- siz-ed ::is Cl .l C.)1� , 19 93 ....-_. I j ' ---!-- ---- _- ( - '- -' — -- ' - ! ^ - • __ - - - --- -- s - — . _ 1 Q - I ` --- _,___,__.7,_ -�----� . - _ - -. - - _ . -Y- - I - 1 IitH— • a ;- r ' - I i I 1 - - -- - - -- - --- - --- -- -- I -- i ' I r , - - - - -- 1 I - -- } yEl I I I I I , I 1 1 ' I • • ' l - - - - - -- f I --- -- - ' -- -1- - -- - - " 1 1 1 I ' I Qat % zr2, o ^bX� �Ics i - - I s S� ? � - 1 , ;xh ' - • 1 _ . 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