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Home My WebLink AboutBLD-93-651 . YAR'r rC* 40,g1Pol, it - �Y s � o TOWN OF YARMOUTH .3 K r« ei�1Q3 �• MATTAOXC $ 4'1 - "4..an�.A 0/, Applications for a Permit to Build No. 5/ UPON FINAL APPROVAL t 9-4-1J MAP 5- LOT Al- `a 0 FEE MUST ACCOMPANY THIS APPLICATION. DATE S'..--pl., C - 19 -- The undersigned hereby applies for a permit to build r/ 7/9_3 according to the following specifications "9-7/93 1. Name of property owner f 7R Ku —r: O �o. d.v o �2 a /93 Tel.-Ire- 4929 Address // Crg.(a+),v S". 'Wacoti-eri. AA. a/6o3� 2.Name of Architect(if any) Tel. 3. Name of builder 6 w w ER_ _Address w 4. License No. Tel. 5. Name of Mason Address 6. License No. Tel. / 7. Construction address 3 0 fr RA.A.474 R47. /S71 yei R /torr4`I , lJq, Flood 8. Date of subdivision Approval plain zone c____ Z istrrict R YO 9. Private dwelling 0 Estimated Cost i o.ry DO NOT WRITE IN THIS SPACE 2 Type of room No. 10. Multi family 0 �jecia• ✓�P gv�`��e�l�� c 11. Commercial 0 err,. �l � / - ` r Kitchen 12. Other � X/y i tten r /pug Dining Rm. 13. No. of stories 00 Living Rm. Bed Rm. 14. Foundation— Full 0 Half 0 Crawl 0 Slab 0 P-I —/'9 ` °' ibJ ' _ i ��,/� 15. Materials — Wood 0 Cement 0 Other 0 Deck�f.&co I 16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 ,A-S---/COO Closed porch 17. Garage — 1 ❑ 2 ❑ Family Rm. 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 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 Signature 46.4% o �� PLANNING BOARD c/Rddress /1 ad124e7" SS. ftt/orCr- S 'lea. /ry, Date OCG°3- 1,1549 1,/ 49 cvA BUILDING PERMIT APPLICATION SIGN OFF APPLICANT: /y/pR u ' <0 CONY N o/Z�t. BUILDING PERMIT #: ADDRESS: // 41(41-541,9 �enC�SIlar ./Y/}. TELE.INO. : 75'.7- 492? DATE FILED: 13 `93 BLDG. SITE LOCATION: 73 D CyggA4 4p7. �jfr4/ iw/)1AP#: 51/ LOT#41" 5 O 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!i 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 // gi F/DATE: .a/f 3 N/A: I�4ST AND/OR COMMERCIAL PE' ITS G S. 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. COMMENTS: BIM/89 9/5/92 1JAP ' - 1,4, PLOT PLAN • FOR LOT # s o • Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) . Well ug ,• I1 I • (lot / 3 'r ft. rear) Abuttor'sI Abutt Name �„ Name Lot # \. ® 4 f Lot # REAR YARD .? .r. If this is a • SZ g Al Pas' - y°`7r.„, %1 1 a5 If t1 • corner lot, ft. corn- write in name - writ of street. • ECK _ _ . I - name i a. othe •° ' : i. , ' -0 v stree to i ,d 4 , • SIDE YARD SIDE YARD 0 .SCr � FT •. HOUSE 4 37' FT0 �J • • • lel I �. • I . SET BACK 3 - 41 . .•. 'f ..ft. 4 I I p r (lot i3sft. frontage) .. • \ / 3 0 e"khAti g7, \\ // (NAME OF STREET) - • / / \\\ -Information 4�.J `%O” / \ Supplied by �" / J TOWN OF YAMOUTH BUILDING DEPARTMENT - -HOMEOWNER LICENSE • mi TION PLEASE PRINT: DATE c( - Z 0 - 3 l n� / �y JOB LOCATION -j o en,c / 4- T n ,]'s` . '_J 4,; »;tek i %. NUMBER . STREET ADDRESS (/ SECTION OF,TOWN "HOMEOWNER" /Yi4/{g d /INN(' fa - -7S..? .4 NAME HOME PHONE WORK PHONE . • PRESENT MAILING ADRESS //. !_•ta'A,64-oN 8* /Lion CF_3--F_R Hid • 0/6o3 ,°• 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 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 WUICN 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 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) DIE 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 THE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE WILL COMPLY WITH SAID PROCEDURES AND REQUIREMENTS. HOMEOWNER'S SIGNATURE Ifr 9 --17.494 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 pclicy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 0 No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 0 Other type of indemnity 0 Bend 0 • OWNER'S INSURANCE WAIVER: I am aware that the licensee does net have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature cn this permit application waives this requirement. k<45. Cep. '" / Check one: • Owner*, Agent ❑ Signature of OAter or Owner s Arent __ _ 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 h{GL c.142A requires that the"reconstruction.alteration.renovation.renair,modernization.conversion.inpmvement,removal,demolition. or construction of an addition to any pre-existing owneroccumed building containing t least one hut 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. J e� Type of Work: (R,1 1 A 4,C6 i y n�i' et C pl, q� Est. Cost i� Address of Work 13 0 exAm+ OS s'. W/=s� �Y4Rflo A . Nom Owner Name: fiur/{ '-y� D Cow Ngo n Date of Permit Application: a -.7 0 93 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law .. Job under 31,000 _Building not owner-occupied XOwner 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: V-4,o- 93 iii Date Owner Name . ' 7 0-9`-. COMMONWEALTH OF MASSACHUSETTS - _ __ ____ C -`Pk • DEPARTMEIC OF INDUSTRIAL ACCIDENTS ' 600 WASHINGTON STREET James Camooei; BOSTON, MASSACHUSETTS 02111 • . Commissioner • WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • �� r �9 &/v is, a v i (licensee/permittee) •/with a principalplaceof business/residence at. l/ (,e+7/ R e-Ilorr St'. RC ES r- A / f)'/4 e CO C6 t (City/Sure/Zip) - do hereby certify, under the pains and penalties of perjury, that: c;: .- - .. _. [] I am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number KI am a sole proprietor and have no one working for me. 1 am a sole proprietor, general contractor circle one)and have hired the contractors listed below. . r who have the following workers' compensation insurance policies: :.._ -... . . -• . Name of Contractor . . Insurance Company/Policy Number . . . ...-... . Name of Contractor - Insurance Company/Policy Number - .. " - • a Name of Contractor Insurance Company/Policy Number . X1 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 overage • verification and that failure to secure Coverage as repaired under Section 25A'of MOL 152 can lead to the imposition 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. q Signed this day of (97 , 19 / L icenseeiPe:mit e.t Licensor/Permirzor • . yam — i i is . t ' . 1 j I_ • j /m I _. ren •2�i'/VO5 co --ice - `�, -- -- - __ - o'/ CC 1 , \e ; •, , , ../„ 4 4e 1 • • '1 , V/ i 1 ratil oN .rte �,9E N!h/ • • / d Ifri / ....4.!..ii. 1-.-........ " trier•-• .""j1-.-.1:1a2".•rir .......siZ. .--7•••ei.ri . i • • (/ �l / Jam"- 'J •'/ ��2 0`! 4 • - z1 1 0kiy2K7 Z .V.90711 ..�.. f ._.._.^_• __ .40f, .: .y�•. 1 i it:!