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Home My WebLink AboutBLD-93-663 / ._ _ 4•.Y4 `%' TOWN OF YARMOUTH feral) 0(A \\ yI • TTA-C111 5 � %,.,0•11An.` 0i Application for a Permit to Build No. 663 UPON FINAL APPROVAL P 03 MAP ..?-3 LOT �/q FEE MUST ACCOMPANY THIS APPLICATION. DATE 1 The undersigned hereby applies for a permit to build .3//93 acc ding to the following specifications (i1. Name ofproperty owner?•cl-Qri G �0.�^1«te-- el. 717 c��`s7 Address U 7 Par ptiv— tfcllt•-t R+) • w /cr..i.,4t. moss • oic73 2.Name of Architect(if any) Tel. 3. Name of builder ottntJ.c) Address 4. License No. Tel. 5. Name of Mason Address 6. icense No. Tel. Construction address c/7 Carl rt s Y ✓C_t<< o . LI • r�o"T(.. _ FlooItoc d District 6_y� 8. Date of subdivision Approval plain zone 0 Zone 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE 10. Multi family 0 x/5 00.. H' Type of room No. 11. Commercial ❑ a delacct., 133/j Kitchen 12. Other /_ �(( �� Dining Rm. 13. No. of stories-7 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 0 2 ❑ Family Rm. Sun room 18. Swimming pool - Size Garage 19. Storage shed — Size Shed 20. Stove — Wood 0 Coal ❑ Alterations ;1, 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 Signature4 � C Y 1 11- PLANNING BOARD Address 4/7 Pon_1i7at q &/a-Ca eW. Date -201<2,1 2n • 07673 TOWN OF YAMOUTII BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE g }7 -93 JOB LOCATION Q dp - r��//ll 11 ea( L0-90(< M\' T,�• / )3 NUi� STREET RJCSSSECTION OF,TOWN "HOMEOWNER'' 1 CLO,sei 'L C • NCltrk _pc" -77* Vla-°) l 1 OF'V 7 • NA1.4E HOME PHONE WORK PHONE PRESENT MAILING ADRESS L( ` 1 Pc the L/C( ear . • Ll. ) I- ja eLnvimA All JA ` c- . J o (-,7:cC TY 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 1;110 DOES NOT POSSESS A LICENSE, PROVIDED THAT TIME OWNER • ACTS AS SUPERVISOR. (STATE BUILDING CODE SECTION 109.1.1) DEFINITION OF HOMEOWNER: PERSON(S) WHO OWNS A PARCEL OF LAND ON WHICH 11E/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 THE BUILDING OFFICIAL, ON A FORK 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 TUE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY—LAWS, RULES AND REGULATIONS. TUE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT BE/SHE UNDERSTANDS THE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE -' WILL COMPLY WITH SAID PROCEDURES AND REQUI/R�EMENTS. HOMEOWNER'S SIGNATURE c Y l APPROVAL OF BUILDING OFFICIAL NOTE: THREE FAMILY DWELLINGS 35,000 CUBIC FEET, OR LARGER, WILL BE REQUIRED TO COMPLY wird STATE BUILDING CODE SECTION 127.0, CONSTRUCTION CONTROL. INSURANCE COVERAGE: I have acurrent„t liability insurance policy c; its substantial eq,uiry aIent which meets the requirements s at MOL Ch. 142. YesZ No ❑ If ycu have che,ked vess• please indicate the type coverage by checking the apprcpriate box. A Iicbily Insurance policy X Other type of indemnity 0 Ecnd 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance cc._race required by Chapter i42 Cii:C Mass. General Laws. and and tha: my signature cn this permit, appli•ccticn waives this requirement. irement. C 'CC< °Tyner AG r ( — c;.._,icre c: Coiner cr C' te:s :.cent Suggested Affidavit for Home Improvement Contractor Permit Application For Omce Use Only - NAME OF CITYITOWN Permit No. Date AFFIDAVIT Home Improvement Contractor Law • Supplement to Permit Application MGL e.142A requires that the"reconstruction,alteration,renovation.repair,modernization.conversion,inprovement,removal,demolition. orconstruction of an addition to any pre-existing owneroccuoied budding containing at least one but not more than fourdwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other requirements. c -- yr Type of Work: 02 S 114-e ILS • Est. Cos "TrucC Address of Work [ 7 PO4 J2/ cid-eel ed. K/•v4. (7k . 62673 Owner Name:g f dwu ( C C . /� f„ f(� Date of Permit Application: E'A7-52 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 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 -11 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: Rea-7-73 Date Owner Name • i 17..•• _ 6. P COMMONWEALTH OF. MASSACHUSETTS __ DEPARTMENT OF INDUSTRIAL ACCIDENTS E _- 600 WASHINGTON STREET . tames J CaMpoell BOSTON, MASSACHUSETTS 02111 . C.omm:ss one WORKERS' COMPENSATION INSURANCE AFFIDAVIT • I, (Rfaka4/10C e.- X.kt,ii/Crier.— (licensee/pet-mince) • with a principal place of business/residence an (49 Par-I- 7/fir Jc io.s ti ed . )). (144_ - n?673 (City/Sum/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. (J.N am a sok proprietor, general contractor 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 , I am a homeowner performing all the work myself. NOTE_..Plcuc be aware that while homeowners who employ persons to do maintenance,construction or repairwork on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto arc 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 len] 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 Acddents' Office of lnsuranc for coverage verification and t a:failure to secure coverae as required under Section 25A'of MGL. 152 can lead to tie imposition of criminal penalties consisting of a fine of up to 31500.00 and/or imprisonment of up to one year and d.ti penalties in the form of a Stop Work Order and a fine of S100.00 a day against me. Signed this day of , 19 ._...Q c VI :tic:rs:.iF:....,.._- Licen o:;F:rrnizzn.