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Home My WebLink AboutBLD-93-659 ` (Lrw $s 'f o TOWN OF YARMOUTH Viola ` MATTACM[ 5 / 1 07 C6,,<0..n.. - Application for a Permit to Build No. ifd 9,30_..- th3 S-34 UPON FINAL APPROVAL MAP LOT G- FEE MUST ACCOMPANY THIS APPLICATION. DATE 8/3a 19 9S The undersigned hereby applies for a permit to build 8/30,93 according to the following specifications 1. Name of property owner %�4N/t4h JJ Tel. 7,40-36 9°V a2c 7---2---/red 47.07. 4' f ns 2.Name of Architect(if any) Tel i a Name of builder -tee' _ v 1€ 9e—if;- •ddress -?�.2 . f.e. 4, 04 4. License No. _6/2"=e Tel. `'398 Ca I/ 5. Name of Mason Address 6. License No. Tel. BB 7. Construction address .726 .2f�- a/ �, 8. Date of subdivision Approval plain ion G District R 10 9. Private dwelling Q' Estimated Cost DO NOT WRITE IN THIS SPACE Type of room No. 10. Multi family 0 252,-0•- �0/° Ke piQs 1 11. Commercial 0 e m re/V �� Kitc n 12. Other 0 Dining Rm. 13. No. of stories nil-. 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 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. /All/Ye / LOT RELEASED BY Signature, 4,-r t r. .1 di PLANNING BOARD Address -2.32- _*.t-...: ,.i., Date ifr •.Aroti I\ i BUILDING PERMIT APPLICATION SIGN OFF APPLICANT: ..,.*74.1 .A .24/44// BUILDING PERMIT it: „}' ADDRESS: ..� 5,3744.4......11.97.4:44,744.01, TELE. NO. : 3illi'--G464" DATE FILED: MAY BLDG. SITE LOCATION: ..726 1`t/ 4V ,, 4,4„„NAPIf: LOT//: THE FOLLOWING INFORMATION OUTLINES THE PROCE URAL 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. : 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 DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. 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 • Suggested Affidavit for Home Improvement Contractor Permit Application • For Office Use only - - _ _—_ , NAME OF CITY/TOWN Dale • AFFIDAVIT • Home Improvement Contractor Law Supplement to Permit Application MGLe.I42A requires that the"reconstruction,alteration.renovation.repair.modernimtion.conversion.inprovement,removal.demolition. or construction of an addition to anv oretcisting owmer.occunicd building containing at least one but not more than four dwelling units....or to structures which are adiacent to such residence or building"be done by registered contractors,with eenain'eceeptions,along with other requirements. • Type of Work: /�� rte, / Est. Cost 02 7r-C �i.l Address of Work . 2A' fro-n.4 Owner Name: • Date of Permit Application: g /gj 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 Owner pulling own permit _Other (specify) Notice is hcrcby given that: • OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVENIENTWORK 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 accnt of the owner: / .4,fig Dd a Contractor Name Registration No. OR: • Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Cwner N'.t.rc ' COMMONWEALTH OF MASSACHUSETTS — arra .: � _;_— �' }_ _ - DEPARTMENT OF INDUSTRIAL ACCIDENTS - �� - 600 WASHINGTON STREET James Campoe�t BOSTON, MASSACHUSLI IS 02111 . rommiss•one' • - WORKERS' COMPENSATION INSURANCE AFFIDAVIT • 1, �`i� -/ a- 44.2c,ta.„ (licensee/pertn• cc) . • with a principal place of business/residence at: (CirylSute/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. ‘..d; Insurance Company Policy Numller [ ) I am a sole proprietor and have no one working for me. i ) I am a sole proprietor, tenend contractor or homeowner (circle one) and have hired the contractors listed below who have 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 awue that while homeowners who empioy persons to do maintenance,construction or repair work on a dweiiin; of not more than three units in which the homeowner also resides or on the grounds appurt tart thereto are not tcneraily considered to be employers under the Workers' Compensation Ar.(GL C. 152.sect. 1(5)).application by a homeowner for a license or permit may evidence the leral suns: of an employer under the Workers' Compensation Act 1 understand that : c.pv of this statement will be forwrd:d to the Department of industrial Accdens' Of lee of:nscr-c for c. vcraze 25A'of MGL 152 can lead to the imposition of criminal penalties Ve.^.:Ie1::Y.. :nd that failure to See_7e CD Ve.�e as 7Cn L'i7ed under_C__Jn ccn:s:ne of : fine of up to s:500.00 an 'or:.^..p rL'o.^.m_.t of up to one yen:and civil penalties L^. the fa:rn o; : Sm: 7.Cori: Order and a fine of 5100.00 a day:rain::me. ss Sicn:s: :nis a---...--14.--f A. day of\ ,' 53 , 19 9 3 I...:::::-::::::=1:::::: :..__n._.:f•_......._.