HomeMy WebLinkAboutBLD-93-666 Pr'
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'� 4 TOWN OF YARMOUTH cKFew I</3*'
es,,,«ro. ,0.5) ; Application for a Permit to Build No. X66
UPON FINAL APPROVAL c .3/ 93 MAP /01/ LOT Ftp
FEE MUST ACCOMPANY THIS APPLICATION. DATE 19 '1 3
The undersigned hereby applies for a permit to build rp3//e3
according to the following specifications 0/3/ 93
1. Name of property owner a ito P21 a
Tel.771-60l'7
Address ac
' l ( I�
I .Pstvwu . ClirciLutodfo
2 3
2.Name of Architect(if any) .-, � Tel.
3. Name of builder f ,n"° / 20 ( sr u1Es7ra) Pa.
4. License No. QitSr3( Tel. 16 0-1/00
5. Name of Mason 13 $ Address
6. License No. Tel. _
7. Construction address CH7fg otr Peiffles-r-u-aa-c-
8. Date of subdivision Approval plain z e fit i 6-1- i o) District j�
p
Zone l� - -4‘.5--
to
4S
P
DO NOT W TE IN THIS SPACE
9. Private dwelling 0 Estimated Costjr-s— ,/jpa ,/ Type of room No.
10. Multifamily 0 /700. �' �, _• {�
11. Commercial ❑ 1 �,�ne Kitchen
LEL12. Other /b �/ Dining Rm.
d` Living Rm.
13. No. of stories / -_ 19°5f 30• eniBed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 /o -o-t.BP
Bath
15. Materials — Wood 0 Cement 0 Other 0 '1 1 L Deck
16.Type of heat — Oil 0 Gas 0 Electric 0 Other ❑ Closed porch
17. Garage — 1 ❑ 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size Garage ,
19. Storage shed — Size /0 X/V Shed /0 XJ4
20. Stove — Wood 0 Coal 0 / Alterations
21. Size of lot: No. of feet front NO ' No. of feet rear /Va / No. of feet deep /00 /
22. Size of building. No. of feet front g / No. of feet side /d f No. of feet rear CP
2a Distance from nearest building: Front 1/7 / Ft. side 9 f
7 FtT.l�sir /d-r de Rear 6 p /
24. Distance back from line or street 701 / Fr• •• ear lot line 8 / Side line /a /
25. H.I.C.R. No. /O9379owMidifLOT RELEASED BY Signature r%� //
PLANNING BOARD Address , /tee 6-ear _a
ii,
Date j
S' ti�
h . f /g.3 et.,.
PLOT_PLAN
FOR LOT if •
Indicate location of garage or accessory building
Additions with dashed lines
Sewerage disposal (cesspool) e .
Well
I (lot /40 ft. rear)
01
Abuttor's I ' Abutto
Name I — -- Name
Lot # Lot #
i 5-11,9 /2 -,
REAR YARD
If this is a • ( — _ , • If thi
corner lot, .. :s2.3 . . .ft. come.
write in name write
of street. • I name
i., • - . - - a other'
•Q0 v street
'
SIDESYARD y SIDE YARD
• /
(I_2 t — FT_ () • HOUSE L 57 FTO •
•
a
• I
. SET SACK
•
.37 ft.
I
I
•
(lot /40 ft. frontage) .•
•
•
/ 1•11/Ne Hes rep vic
\ /
• / (NAME OF STREET)
/ •
•
/ Information _ c�� i
/ \ \ Supplied by S/ G/- 7C(lUl� 1
/
TOWN OF YAMOUTH
BUILDING DEPARTMENT
HOMEOWNER LICENSI; E a I TION
PLEASE PRINT: �- p
DATE PU^-�UEk I t) I/ . (�
JOB LOCATION V OS �'vw' U'PC PN aoe , 1O + t4.an wS UU p4-
NUMBER STREET ADDRESS SEDITION OF,TOWN
"HOMEOWNER" {�rti -rl 'ict l Cr 101- 27/-4067 • ,'
NAME S HOME `tP''HONE WORK PHONE •
PRESENT MAILING ADRESS aS ti 4 efr 9(01° .
Wpct 63623
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 W110 CONSTRUCTS MORE THAN ONE HOME IN A TWO-YEAR PERIOD SHALL NOT BE
CONSIDERED A HOMEOWNER. SUCII "HOMEOWNER" SHALL SUBMIT TO THE BUILDING OFFICIAL,
ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT HE/SUE 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.
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 PROCEDtRZEi : a I TS.
HOMEOWNER'S SIGNATURE
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 curre ' liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes A No ❑
If you have checked ves, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy p( Other type of indemnity ❑ Bend 0
•
OW -. 'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Ch pter 142 cf the Mass. General ws, I that my signature on this permit application waives this requirement.
Check one:
Owner 0
Agent
S ntsre ct Comer or • ,er s ;t ___ _
Suggested Affidavit for Home Improvement Contractor Permit Application
For om«Use Only •
QOF�OWN
Permit Na
Date
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c.142A requires that the"reconstruction,alteration,renovation.repair,modernization,conversion.inprovement,removal.demolition.
or construction of an addition to any preexisting owner-occupied building containinzat 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: ari5rgieer Ste Est. Cost (706;
Address of Work 2S Wilke(PAW' r tOed ( gptoot% W#r O 173
Owner Name: -My i GI A (J r
N.)
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 •
Building not owner-occupied
E.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
c. 142A.
Signed under penalties of perjury:
I hereby apply for a permi e agent of the owner:
e ' 3 1 nigh ,/69.3211
Dat Contractor Name Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
Date Owner Name
` 's_ COMMONWEALTH OF MASSACHUSETTS /
_ �/
P -�0 6
�• -<� . DEPARTMENT OF LNDUSTRIAI.ACCIDENTS
t�y' 600 WASHINGTON STREET
James Camvoei, BOSTON, MASSACHUSETTS 02111 '
"p nm sstoner WORKERS' COMPENSATION INSURANCE AFFIDAVIT
I, fe,.,, ,& „3d e 647,, A,„,,,,
(licensee/permittee)
• with a principal place of business/residence an
(cry/Stare/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
Flo .
a � 0a 3.%%q6s—flit -
Insurance Company Policy Number
( ) I am a sole proprietor and have no one working for me.
•
( ) I am a sole proprietor,general 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 _
Q I am a homeowner performing all the work myself.
NOTE:_Pleue 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 lnsuranci for coverage
verification and that Failure to secure coverage as required under Section 25A'oFMGL 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 5 100.00 a day against me. /
Signed r' O2e day of . .. �.i/ 19 92
Lice :Permtr:ec'
Wa LicensoriPermiaor