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Home My WebLink AboutBLD-93-657 wr t TOWN OF YARMOUTH grew 04, • TTACH441M6 Application for a Permit to Build No. 7 UPON FINAL APPROVAL MAP 77 LOT W " I ` FEE MUST ACCOMPANY THIS APPLICATION. NDATE 9 3 The undersigned hereby applies for a permit to build according to the following specifications �f 049 -303(0 \1. Name of property owner -t I4O44I15 P. Rs-a- ti vAne Nr&timel. anal.6 q`A \Address 7 /Re DOf Wo p /C( 4T71.48ota 2.Name of Architect(if any) Tel. N3. Name of builder • O Ca Ai&.P.. Address 4. License No: Tel. 5. Name of Mason Address 6. License No. __ Tel. \7. Construction address -5-4 'My WOOD Qe{ %All Flood Districtsg_ y0 8. Date of subdivision Approval plain zone 9. Private dwelling 0 Estimated Cost -tea' ,y� DO NOT WRITE IN THIS SPACE g ra %i adeniqType of room No. 10. Multi family 0 \ 30 0& 7/23/9•373n-L..- Ra-Novn-Wont 1 11. Commercial 0 Kitchen 12. Other ❑ G am' .3 5-, 0.e Dining Rm. 13. No. of stories `j 0 , 0_0 DEP Living Rm. di Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 O L 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 18. Swimming pool - Size Garage 19. Storage shed — Size _ Shed 20. Stove — Wood 0 Coal 0 4 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. q LOT RELEASED BY \Signature 9/1.41,..6 P. QPKa.,- PLANNING BOARD \Address Date , , - '4 TOWN OF YAMOUTH •, BUILDING DEPARTMENT ' HOMEOWNER LICENSE • mi TION . PLEASE PRINT: �} DATE t8-" 3—'Ii 3 JOB LOCATION AMY LoOQO Avg S. visOktoott+- NUMBER STREET ADDRESS SECTION OF;TOWN \"HOMEOWNER" rik fr145 ,p„ 8 61.4,4 VA Ae C.e 11- 6 -3,12 3(, . NAMEHOME PHONE `, WORK PHONE . PRESENT MAILING ADRESS i`a 13401W to6DD AN 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 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 TUE 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) THE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH THE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGULATIONS. TBE 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 9 /Law/iv P, Qf 2tt'a_u_c�c• 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 cu e liability insurance pciicy or its substantial equivalent which meets the requirements of MGL Ch. 142. \ Yes No ❑ If you have c, e_ edf, please indicate the type coverage by checking the appropriate box. A liability Insurance pc,icy k . Other type cf indemnity 0 Bcnd 0 OWNER'S INSURANCE WAIVER: I am aware- that the licensee does not have the insurance coverage required by Chapter 142 cf the Mass. General Laws, and that my signature cn this permit application waives this requirement. n /fie eck en : (Jf` Owner g Agent 0 ..Signature ct Onr.er cr Owner s Agent __ , - ___ — Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only • NAME OF CITY/TOWN Permit No. Date AI-FUJAVIT Home Improvement Contractor Law Supplement to Permit Application MGLc 142A requires that the"reconstruction,alteration,renovation.repair,modernization.conversion,inprovement,removal,demolition. orconstniction 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: „g' fe....C_ Les4a6.4.044 464 fbm pY'1CkFst. Cost egiCbot,? \ Address of Worku �p � \ Owner Name: r-Atom -S P /SL t.4 1 ntvct- \ Date of Permit Application: +'a''� \ I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 Building not owner-occupied \ Wgwner pulling own permit cher (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: Date Contractor Name Registration No. OR: • Notwithstanding the above notice,� I hereby apply for a permit as the owner of the above property: f - 'gil) q`[mm f_-Y'4 tC✓Xie rlfd ty<� Date Owner Name . . •t=.- COMMONWEALTH OF MASSACHUSETTS • �' ----c DEPARTMENT OF INDUSTRIAL ACCIDENTS - ' 600 WASHINGTON STREET James Camooeu BOSTON, MASSACHUSETTS 02111 ' mor m:sstoner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • \ I , (I i ce n s ee/permiaee) • with a principal place of business/residence an (City/State/Zip) do hereby certify, 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 [) I am a sole proprietor and have no one working for me. .- - . • [ ] I am a sole proprietor, general contractor o' • •• t rde one)and have hired the contractors listed below :. who have the following workers' compensation ins cies: : . -1- . . . .. . • Name of Contractor _ . .. Insurance Company/Policy Number..: - . _. ... . Name of Contractor - Insurance Company/Policy Number . • - • r • Name of Contractor Insurance Company/Policy Number . - \X I 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 1 understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of Igsumnci for coverage verification and that failure to iecure coverage as required under Section 25A'of MGL 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 S100.00 a day against me. Signed th d ii- L!� _ day of 8-)3-- , 1913 \Li Cep,scc/Permi Cel Licensor/Permittor Sok) PLESS A 1 S-AAY-w a et O_9 Y_t .1- - -- -- l8 S E T . tu t lab Le.) s et pc6R • 3 4I PR --. ALuM ours SrbQM TRIPCc TRAGIC I 3 ` 12 117 opo, ± • 3! st 3t • , 3 ' 3 ' 3 ' V =1- - 1 gr-1�---tet-i ":-- t f I t 121 '7 ^ i+ LQ N1kitt c_____ /") n"-1vi ‘AQ �� 1 S0N p* Q. c (.l. )v o N cA'r Gt 5LIDE-R i i f 1 I I 2- t f , 5 ' f - p o o R ----",.....J1/ _ --- 4. 1 --X4 coNs1-Rocttot, CA5t /v1ENI