HomeMy WebLinkAboutBLD-93-650 , - _ ,,RIF
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'•v-; ' TOWN OF YARMOUTH o 0/16/13
e6, ."0"Im+ 07 Application for a Permit to Build No. a
UPON FINAL APPROVAL %'a�, . MAP LOT r0-I
FEE MUST ACCOMPANY THIS APP!LP4rrlON, DATE Y—/Oc(' 19 7.9
.. .:''.
The undersigned hereb9applies a
for a perrrliit to build 7 1.19 . .
"cording to the following specifications% ','
V1. Name ofprop *owner 4ebn c. 1`-4i'22-i-id-ye m- NWhK.4Ln- C ,g 41,29>
1, Address V) Att7 e9e L ''j21e7- Ad, at Minov74 AN
.Name ofArch)tect(ifany) , .Tel.
3. Name of bufder ' : ._,:n.Launasd zr:._Address R no X is- 1 tANK-towS
- '�s/5., 4. License No. 1.4 2828 a Tel. 9C 2 'S.VV�
5. Name of M asoh_»e __Address
/License N ,.` Tel.
7. onstructi naddress <%) Mipti �[/4zZer rto. vatOflmvTZ //f/¢,
Flood District '
8. Date of subdivision Approval plain zone Zone
9. Private d elling Cd" Estimated Cost - g OJOT WRITE IN THIS SPACE
10. Multi fa ily ❑ /3, oov, " ( ^PBs'T yo. ^ Type of No.
w ao
11. Comme cial 0ettKitchen
i'" �. 0� Dinin Rm.
12. Other ❑ S' 9
13. No. of stories 0 - 0-0 t�' Living Rm.
$9L Bed Rm.
14. Foundation Full 0 Half 0 Crawl 0 Slab ❑ y{ 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 0 2 ❑ Family Rm.
SuGan 18. Swimming pool - Size I B—',NC - - Ga' n m
' 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. H.I.C.R. No. /�
LOT RELEASED BY Signaturl UJ Cad o.ik S —
PLANNING BOARD Address fin, hag 757
Date i1'1trr,1/d2L5 !'V1iaS� l�fi-Dg yr
APPLICANT: it/ SCLi�/lPit BUILDING PERMIT i:`: p54� grF� ��9J
ADDRESS: )4 elOX 217 ,,Pf1/4y�HS M22::1 TELE. NO. : 4 °'5TF?3 DATE FILED: 8'/D -fl
BLDG. SITE LOCATION: 47 ,.x' I e // eji /61 MAPi: LOT//: /9'
THE FOLLOWING INFORMATION OUTLINES THE PROCEDURAL STEPS REQUIRED TO OBTAIN A PERMIT TO BUILD,
ALTER, OR ADD TO A STRUCTCkE 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: -
RESIEJJ:'TIAL AND/OR COMMERCIAL BUILDING
•
WATER DEPARTMENT: DETEK`TINES COMPLIANCE OF WATER AVAILABILITY.
ENGINEERING DEPARTMENT: DETEEKINES COMPLIANCE FOR PARKING AND DRAINAGE.
CONSERVATION COMMISSION: DETEI;MINES COMPLIANCE TO WETLANDS ACTS, I.E. : IF LOT(S) BORDER ANY
TYPE i-F 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 THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR
ISSUING THE REQUIRED BUILDING PERMIT:
REVIEWED BY:
\4. WATER DEPARTMENT,')"., .) i , i h r ,-, t DATE: c -• t r7 -47-5 N/A:
2. ENGINEERING DEPARTMENT: DATE: N/A:
3. CONSERVATION: / DATE: N/A:
4. HEALTH DEPARTMENT �l� 7 AL DATE: w /j.+/� Z N/A:
I STRI 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: ICI-t-`e - p' _ ;,...,fie'- ¶ r ' . . ;1 i 51, r nL) ("' k) c_+
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' Pg �larrc t c$ r 820474 •
gib/ 54 ear fin 4 iliewcryineltexis- :
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AUG 12 93
��iluv okM) � pizLy2t 1(4t
` ***ONE HUNDRED DOLLARS-AND CENTS •
.E.R*.*+.b.k.EN.t-tU100 . 00 /
• 1��I / E
• , ��4 .Dpi
"00820474e 1: 2113 ?Li 4481: 6711.0000 IAN, 70
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• COMYOM,VEALTN 1010 COMMONWEALTH AVE. ;�/
of 110310N,MASS.o2215 • . • .
MASSACHUSETTS . ENCLOSE CHECK OR MONEY ORDER .
•
LICENSE . FOR REQUIRED FEE,
EXPIRATION DATE Qc.0 CONSTR. SUPERVISOR• • •
•
02/28/1994 6J.” . MADE PAYABLE TO
RESTRICTIONS EFFECTIVE DATE LIC�10.
. • NONE `p 02/28/1992 042838 ff "COMMISSIONER OF PUBLIC SAFETY"
WARREN F
: SSN 010-42-7275 COTUIT MA 02635 - -Ir ["� - p9p7�SfE/JE •
•
.
mom IMwEr4O Ors orun FEE: - . APR Z IIP. .• .
. ' •' . 100.00 .
e_x._ -.-.
.
3*A'Er -11;K:
} HEIGHT: NOT YAW UNTIL fGNEO St ICENLEE AND OPPK.LLY - '-
A: i€___ 3!9tlLRNE TM� sloNEa
-fE DOS;
.^1 EW"( P#ETelf41.WE�ISE .STUB
• �1.�° 05/22/1950 DO
�� -,�, �-J�i ° EN. DOCUNTHE cosi Y SIGN. NAME IN FULL-ABOVE SIGNATURE LINE
. .Yp . 4T! CAMEO ON ENE PERSON O I �S51fINAIUgE OF LICENSEE
���lll 1' ..., 7R Y o c .* Actina COMu.sslo 1'11
OME •E1RN.Ma COFo N rNiS OCCUTAIr/�Vl - .
FILE #C51190 CENSUS TRACT II to
CLIENT : Attorney Imster J. Murphy DEED ROOK 4150 PAGE 132
OWNER : Sally N. Silver Muller, Trustee PLAWBOOK PAGE LOT
APPLICANT : Richard C. I. Marline M. Nahkala ASSESSORS PLAN PLOT
MORTGAGE INSPECTION PLAN OF LAND
N
YARMOUIH
SCALE: 1m= 60' •
MAY 24e 1985
•
1311' •
•
tif
Q20,344± s.F . / •
ccss, c
o� co . Towiv unfli e;
st M
• qp g4/ ; /8xSc' i •
V •N 1 STORY /'c'"`•
g.1 flea O
•
161 ,84 '
•
•P A RI T R' I DGE V .A 'L�L E• "IY •R �O •A JD
•
I CERTIFY TO ATTORNEY LESTER J. MURPHY, BANK OF BOSTON AND ITS TITLE
• INSURANCE COMPANY , THAT THERE ARE NO VISIBLE ENCROACHMENTS OR EASEMENTS
EXCEPT AS SHOWN AND THAT THIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPERVISION_
.THE LOCATION OF THE DWELLING AS SHOWN HEREON
IS IN COMPLIANCE WITH THE LOCAL APPLICABLE •
�ee �y..
ZONING BY—LAWS WITH RESPECT TO HORIZONTAL :Tt(F•NNCTH i •,
..DIMENSIONAL REQUIREMENTS . I4p, �t
ij FERRE,RA I .
-/, tto.26T1e, �g
THE DWELLING SHOWN HERE DOES NOT FALL WITHIN `•^t . 4.4mtvev4 t
A SPECIAL FLOOD HAZARD ZONE AS DELINEATED "f
ON A MAP OF COMMUNITY #25OO15A DATED # a.
5/2/77 BY THE F , I ,A , •
•
Lend Surveyors CMI Engineers
®Ibe Boston Pub Sultry Co., Pint.
172 ,lillinm,�►l.
• Pau !latera, A U2r4o r
GENERAL NOTES! (1) The declarations made above are on the basis of my knowledge, information, and belief's, the
result of a mortgage plot plan tape survey inspection made to the normal standard of care of registered land
surveyors practicing in Massachusetts. (7) Declarations are made to the above named client only as of•this • ';
• date. (1) This plan was not made for recording purposes, for use In preparing deed deseriptlons'or for tipn. ' i1
structions, (4) Verifications of properly lino dimensinns, building offsets, fences, or lotconfigurationsay ; r
he arcnsol lrlu•d only by ..n amino!, Inst rnn.•nt •4ryry, -
-,E. . moi=-„L.
• ter; ' COMMONWEALTH OF MASSACHUSETTS.
v.' -`— c' :.-DEPARTMENT OF INDUSTRIAL ACCIDENTS
. . - - 600 WASHINGTON STREET
James Camvoee BOSTON, MASSACHUSETTS 02111 •
rorn.ss,one' • -
WORKERS' COMPENSATION INSURANCE AFFIDAVIT •
I, ,W e faro _S2&rtr ZM darer rano(s v-41-rn\L-r-gyi roremts
(licensee/permirtee)
• with a principal place of business/residence an.
•
/ (City/Stare/Zip)
do hereby certiry, 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
Y' 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 'nave 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•.Pleue be aware that while bomcowncn 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.
1 unde-:and :hat t copy of his statement will be forwarded to the Department of Industrial Aeddens' Office of in sarand for coverage
vcri;canon and that failure to inure coverage as recuired under Se non 25A'of MCI.. 152 can lead to Me imposition of criminal per.aldcs
fine of up to 51500.00 and/or imprisonment or up to one year and c+v pena ties in the form of: : Work Order and a
consisting of- Sim:
fi£ this
ne or-5100.00 andayy agairs: me.( D .1- da • or 840 , 19 C/3 .
•
:.icea::::. :::::::::: L..^... .rF........_.
•
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 c.142A requires that the"reconstruction.alteration.renovation.remit modernization.conversion.inprovement,removal.demolition.
or construction of an addition to anv pret[isnng owner-occupied building containing at least one hut not more Man four dwelling units....or
to structures which are adjacent to such residence or building'be done by registered contractors,with certain inceptions,along with other
• requirements. G, .
Type of Work: S t4MW� 41 *C en Est. Cost13,era
Address of Work 44Aeic die L/4FGLey Ar Gu, y4i&nov7+, WA"
Owner Name: �rc4n"td C. /o- ,%ML,ne eW. /Y/34k.4ifl
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 as the agent of the owner: •
e-/o -23 W t frreiL c✓"d evi,K
Date Contractor Name Registration No.
OR: • •
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
Date Owr.er Name
• • BUILDING DEPARTMENT .
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT: ' . • •
JOB LOCATION: y} %4r4,dp9 vn1Ley /0/. w• Pber/1 v71 ,Fm, •
• NUMBER / • ' . STREET VILLAGE
OWNER OF PROPERTY: ' ,/C r4 xft4r-/ (•••. Let. fniI"?hive 21, /y/?AJc-AL;4-. [ z'
CONSTRUCTION SUPERVISOR: W • I r.dc, �/�L(i{�W e,44 -Ylly ` 24 ✓ 75
. n� c,• NAME f/�A `1 r . /�. •
S I•. (L/ICENSE NO. PHONE NO.
ADDRESS: • 0 81. 6u 74• ` c l ' "tea ✓ 9 a) 1,15; M k D.)-&
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 COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE
IS SUPERVISING. HE SHALL BE RESPONSIBLE FORESEEING 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
CO•LMONWEALTH, 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 DEIOLITION AS REGULATED BY SECTION 109.1.1 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.
I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR _ICENSING Ct::1
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTAN
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
OFFICIAL. .
INSURANCE COVERAGE:
I have a curr,ent +ability insurance ;clic/or s substantial equivalent which meets the requirements cf MGL�•th.152
Yes/A . . No ❑
If you have checked v_s. please inc cote the type c average by checking the apt:ccriate bex.
A liability insurance pc:icy je Other type at ...demntty 0 Band 0 '
OWNER'S INSURANCE WAIVER: I am aware tilhat the licensee deer not have the insurance coverage requires by
Chapter 152 of the !Hass. General Laws. anc M my signature cn tn:s permit c;:ica:icn wares this requiremen.:.
Check one: •
Owner: Agent 0
Signature of Cener cr Oenet s Agent f
SIGNATURE .s- BUILDING OFFICIAL APPROV • ' '
• t
FOR LOT •n /1/
Indicate locadcn cf garage or accessori building •
Additions with dashed Lines
• Sewerage disposal (cesspool) Cs
Well p Thant/ ztntfThC. •
I (lot / ?,2 ..ft. rear) I
Abutter's • I ; Abettor's
Name IName
Lot # I Lot fl
REAR YARD
:f this is a �� If this '
:ernes lots ft. . Sia/r- yA4c/ corner
.tin name 1 write in
ftr
, street. Cy., I 69' name •of
• < > c ether
7. -. Pr b street.
u
2 11 1/4.
•
I /6 'x 3G• .,
'4) I Sk •
/0/f 1
.o.oz..
`
SID? YA^.7. 1
INC � G 30 t - HOUSE <�` - - -
• I
Z � N
SET BACK
•
a I c
I
II
c.-
(1--
(1 /6/' Fr ' fe ecntace)
•
\ / AZ vszL e/ /4c-2
\ /
\ / (NAME OF STREET)
\ / •_•
/ r
/ \
/ \ 7 //97 -news > /5 I-L YN
•
• . _ _ -.. _1•. -
MAY 24, 1985
• SCALE: 1"= 60'
•
131
-------
• LOT 14
10,344±s, F ,
v Ges3F�+��G
S M� 0— I Taww we e<
J t..
`ti 14/ 8:r
; / 94' :
V •N 1 STORY x'1`4,:_•
S/ieJ
11
161 ,84 '
PARTRI DGE V •A 'L 'LEW :R1O :A 'b •
•
1