HomeMy WebLinkAboutBLD-93-660 twegli
.s-� r-r ,No TOWN OF YARMOUTH
� MA \CCS r
4..a..,a ,.- Application for a Permit to Build No. G 0
Al 3 o
UPON FINAL APPROVAL " g MAP 413 LOT-)
FEE MUST ACCOMPANY THIS APPLICATION. DATE 3019 93
The undersigned hereby applies for a permit to build b l3t3
according to the following specifications //��
1. Name of property owner Gt 4 ' 4 4- FJ&ZD,r ( n ,^rn// Tea.71a-7sn
Addres _ C. . -. -. 5 • . , . ..,#. 1r. Id.
2.Name of Architect(if any) Tel.
a Name of builder_ Address e'yteas-vi//n. az,
4. License No. Tel.
5. Name of Mason _Address
a License No. Tel.
7. Construction address .262 301 - 6" l N K
Flood District 2- j 1
8. Date of subdivision Approval �l7 27(9 plain zone C..- Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
„�. Type of room No.
'
10. Multi family 0 yo 0
11. Commercial 0 (yyfD, Kitchen
12. Other Slow *)3 i vc h7 $3 / Dining Rm.
13. No. of stories Living Rm.
Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath
15. Materials — Wood y Cement 0 Other 0 Deck
16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch
17. Garage — l u Family Rm.
22\❑
Sun room
18. Swimming pool - Size Garage ,
19. Storage shed — Size /2 412- Shed /ix i 1 i
20. Stove — Wood 0 Coal 0 Alterations
21. Size of lot: No. of feet front CV i No. of feet rear 7 / No. of feet deep 99. 71
22. Size of building. No. of feet front /L No. of feet side /7. No. of feet rear /Z--
23.
L23. 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 '# 154 d22fI
PLANNING BOARD Addre/ ?,2S -O - style 44.ce,
Date [70-24.-A-ai2 e' 9-c- 02-6/3
e Suggested Affidavit for Home Improvement Contractor Permit Application
For Office Use Only NAME OF CITY/I'OWN
Permit No
Date
AFFIDAVIT
• Home Improvement Contractor Law
Supplement to Permit Application
Df GL c.142A requires that the"reconstruction,alteration.renovation.repair.modernization.conversion.in provement,removal.demolition.
or construction ofan addition to any pre-existing owner-occupied building containing at least one but not more than rourdwelling units....or
to structures which are adjacent to such residence or building"be done by registered contractors,with certain ace'ptions,along with other
requirements. (�y /�
Type of Work: J / C .Q .O. Shy'/.
Est. Cost/@e)
Address of Work 10t 69 ,8a10- L,.qti /age , i, &rj4
Owner Name: cm, x'470-elncy` CarYz//J
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
Ouilding not owner-occupied
wner 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 theowner:
Qj
Date l/Qi�y�(l• fC' 'J
Contractor Name Registration No.
OR: •
Notwithstanding the aboe f%'/2 notice,tiIJ hereby apply for a permit as the owner of the above property:
Date 09,/^1?)//
Owner Name
•
i
• BUILDING DEPARTMENT •
CONSTRUCTION SUPERVISOR FORM
LEASE PRINT: ' • • _' / - / I '
OB LOCATION: 6. 0�%�I�� A4P to/i imoi th
NUMBER STREET VILLAGE •
WNER OF PROPERTY: ' 4,7, tsea,n/1r �LZ/1^r0 1/
ONSTRUCTION SUPERVISOR: . • ' ' • '
NAME . . LICENSE NO. PHONE NO.
•
)DRESS: -
ICENSED 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 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 DEMOLITION INVOLVING 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 MEDIATELY 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
0 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, REMOVALOF DEMOLITION AS REGULATED BY SECTION 109.1.1 OF THE
CODE AND THESE RULES AND REGULATIONS. IN THE EVENT TEAT 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.
HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS .FOR LICENSING
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERST_:
LHE CONSTRUCTION INSP_'.TION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDIN
FICIA?.
INSURANCE COVERAGE: • •
I have a current liab City insurance pclicy cr s substantial equivalent which meets the requirements ct MGL'th.152
Yes r_' No ❑
If ycu have checked yes. plea__ incic:e the type c::er -e by checkingtheaw.. _ . :
.1.
A liab!ity insurance pc:icy 0 C her type cf ..cemn:ty 0 ecnd 0
CWHE:V3 INSURANCE WAIVER: I am aware that the :.__.^.see dc__ PC! ! i..' the it .c- :ec^,e rec_:rec
C7_s._•152 cf the !Aa__. Ge..^._rr L-ws. an: Ina: my _ .,.r e en ,... pe....,, -cc.,,.a,en wa:ves this require _ _
Check cr.e:
_ - C'.vr.er-7 Agen: ❑
e: C.nner cr UnrRr s Agin:
.
1
•
t ..
COMMONWEALTH OF MASSACHUSETTS
.. . - DEPART/si1ENT OF INDUSTRIAL ACCIDENTS
600 WASHINGTON STREET
BOSTON, MASSACHUSETTS 02111 ' •
James J Campoee
romm,sstoner WORKERS' COMPENSATION INSURANCE AFFIDAVIT •
I, re
cnscermineci 6,...,44/
• with a principal place of business/residence at:
22in }— J--.44� iLv y ,H,red
fri4,2--• O2d7c
(City/StatelZip)
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. -
•
[ j I am a sole proprietor, general contractor o omeown (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 • . . . -
a
•
Name of Contractor Insurance Company/Policy Number
•l; 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
dweiim: 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(CL C. 152,sect. 1(5)).application by a homeowner for a license
or permit may evidence the legal sums of an employer under the Workers' Compensation Act.
I understand that a copy of this statement will be forwarded to the Department of industrial Acddcnz'Office of Insurenee for coverage
verification and tha:failure to secure coverage as reoulted 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 5100.00 a day against me.
Signed this [ , ?� 73 day of , 19 93
,,..i . 6./ - 11,4 �'
ste pitch e....,.._c _ic_nso Fermat-s;
_ - - -- '. - BUILDING PERMIT APPLICATION SIGN OFF
APPLICANT: � 'ltni l inf f' BUILDING PERMIT ll:
7J-...- p �_w ELE. N0. : �3 "ZJ�E DATE FILED: J�
ADDRESS: zz � p--- 44g I ry p i& l
BLDG. SITE LOCATION: °d.� 2Db-U ` f..I„JI� MAP/I: .q3 LOT ll<Sj /
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.: 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:
BLM/89
TOWN OF YAMOUTII
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT: p
DATE /1201123
JOB LOCATION x`67 a jf -o-Z Gam. /,,.2aQ.. �./��oirl>,'titiki,zr
NUMBER
�� STREET ADDRESS / SECTION ddF,TOWN
"HOMEOWNER" � Jf 0 gawp,- 7x-73-r4.-
NAME HO���111EEE PHONE WORK PHONE
PRESENT MAILING ADRESS22,8g-d de/r'A Jit
WI/ ^ , mss 0.6 3
CITYY t 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 WI10 DOES NOT POSSESS A LICENSE, PROVIDED THAT THE OWNER
ACTS AS SUPERVISOR. (STATE BUILDING CODE SECTION 109.1.1)
•
DEFINITION OF HOMEOWNER:
PERSON(S) WH0 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 HOME0'WNER. SUCH "HOMEOWNER" SHALL SUBMIT TO THE BUILDING OFFICIAL,
ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT HE/SIZE• SHALL BE RESPONSIBLE
FOR ALL SUCH WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1)
THE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH TUE STATE
BUILDING CODE AND OTHER APPLICABLE• CODES, BY-LAWS, RULES AND REGULATIONS.
THE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT BE/SHE UNDERSTANDS THE T0WN OF YARMOUTH
BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE
WILL COMPLY WITH SAID PROCEDURES AND REQUIREMENTS.
HO.`SCW:IER`S SIC.I.ITUREC!� � &id
j�
C-/�a.e..,,.r/
APPROVAL OF BUILDING OFFICIAL
NOTE: THREE FAMILY DIELLPNGS 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 Bank/ insurance policy cr Its substantial equiva!ent which meets the requirements of MGL Ch. 142.
Yes ❑ No ❑
If ycu have checked yes, please indicate the type coverage by checking the appropriate bcx.
A U:.bift/ Insurance pricy 0 Cther type cf indemnity 0 Bend 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee dces rot have the insurance coverage required by
Chapter 142 cf the Macs. General Laws, and that ran signature cn this pe.rint application waives this requirement.
Check cne:
Cwr.er 0 Agent 0
PLOT PLAN •
•
FOR LOT # 61 •
• Indicate location of garage or accessory building
Additions with dashed lines
Sewerage disposal (cesspool) e •
• Well 0
_ (lot ft. rear)
Abuttor's _ - I Abutt
Name I Name
Lot n I - Lot #
REAR YARD
If this is a • 6' If th
corner lot, 1 ft• • corns
write in name writ
of street. •: name
'- • I .. • , ..other
-0 . - v , stree
Ma - - v
'V - - - •
•
if
SIDEYARD . � E� SIDE YARD
0 [V FT: r, . , • 0 FT 0 •
0 Y
• • • I
• - I
. ..1
SET BACK . .
o I ft.
H 1 _.
•
(lot 9r ft. frontage) .. •
•
\ / /
\ / (NAME OF STREET)
` •
/ \ - -Information I / /
/ A Supplied by • b .a. • i_.i
/ \