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Home My WebLink AboutBLD-93-667 •. •• OF•Y`lk m K Fe w '� o TOWN OF YARMOUTH rho, 0 p.1#4ta- C ....0. Application for a Permit to Build No. 667 UPON FINAL APPROVAL •• d / MAP 577 LOT 2 '2-- F E E FEE MUST ACCOMPANY THIS APPLICATION.- DATE The undersigned hereby applies for a permit to build ,//79-.3 according to the following specifications 7///93 1. Name ofprroperijrowner �'�0L leUes7 / Tel. 3,73710 Address ,Q7 npPe,,ei *t 04 yF2 f?l: 2.Name of Architect(if any) Tel. i�3. Name of builder F41/ at-is Address lGI12n 6/ed�'i� Tf✓( 4. License No. Tel. 7 7 C-15-4-S`� ).--05.-CL 5. Name'of Mason Address 6. License No. Tel. 7. Construction address 2- 7mi' 'PoXC /3et,o/t SGS7--)1/1/2"7-706177,e- Flood ?1/f2 oUT7, Flood (✓ District 0_3/4)8. Date of subdivision Approval plain zone Zone 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE Type of room No. 10. Multi family 0 1 7,91, ,� K n i�s 11. Commercial 0 Rod eF' f� � �� Kitc n 12. Other ,c5.7. ~` - `� Dining Rm. 13. No. of stories 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 ,om rear lot line Side line 25. H.I.C.R. No. /lP/s'97� d LOT RELEASED BY Signature �A.fWY�QS& PLANNING BOARD Addressla )4-•°,7"-r'`�ir Date tX-rnowesse / �'// ely/i 3 res . Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use only NAME OF CITY/TOWN Permit No. _ Date AI"NIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL e.142A requires that the"reconstruction,alteration.renovation.repair,modernization.conversion.inprovement,removal,demolition. or construction of an addition to any pretcisting owner-occupied hmldine containme at least one but not more than four dwelling units....or to structures which are adjacent to such residence or hmldine"be done by registered contractors,with certain ecceptions,along with other requirements. Type of Work: fie jetrrTF Est. Cost 470,9 Address of Work a, 9 t9 a22m12t i4s€ttd/c lV, Sen ,. rn.51 Owner Name: /Lg- . ve_ 7— Date of Permit Application: 9/3 0/93 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under SI,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 c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: 4/303 � Mfr C /0 / oy Date 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 at {'! 6-' TOWN OF YAMOUTH r`n- BUILDING DEPARTMENT • HOMEOWNER LICENSE EXEMPTION ''PLEASE PRINT: DATE 4/3 0/C1.3 i '�, JOB LOCATION 9 .27 fen 1Kiel- 41er9oX w. y/ #no a ;77# .' NUMBER STREET ADDRESS SECTION OF TOWN "IIOMEOWNER"CMC 9L RA, e67- 19 - 37 & a 4.-1iJ/g NAME HOME PHONE WORK PHONE ' ,31„ PRESENT MAILING-ADRESS o. `7• /lf 7/Lf i9/2 72.0 5W A 17 ' y CITlC�nOR TOWN '/` STATE 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 THE 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 TEE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGULATIONS. , THE UNDERSIGNED "HOMEOWNr'" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH, BUILDING DEPARTMENT MINa INSPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE WILL COMPLY WITH SAID ' : .C:r,URES AND QUI TS. HOMEOWNER'S SIGMA 1 ' . (Zit] _ �•r ' ' APPROVAL OF BUILDING OFFICIAL ' l NOTE: THREE FAMILY DWELLINGS 35,000 CUBIC FEET, OR LARGER, WILL BE REQUIRED TO COMPLY WITH STATE BUILDING CODE SECTION 127.0, CONSTRUCTION CONTROL. • `' 1__ -- , INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL ChS142. • Yes 0 No n-- If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 0 Other type of Indemnity 0 Bond 0 OWNER' SURANCE WAIVER: I am aware that the licensee does'not have the insurance coverage required by Ctiapt 142 Pf the Mas ' en ws, and that my signature ort this permit application waives this requirement. ,/ Check one: V CT/L{ l C Q Owner Agent 0 ' Signature of Owner or Owners Agent _. . .— • . • =_ — COMMONWEALTH OF MASSACHUSETTS:., - • @ DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET James a Camvoei, BOSTON, MASSACHUSETTS 02111 • �pmnrss+onet WORKERS' COMPENSATION INSURANCE AFFIDAVIT • I, P Riehe4e- (licensee/perminee) • with a principal place of business/residence an • M /7? IP'• yetde (City/Sure/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 am•a sole proprietor and have no one working for me. - - - - -- [ j 1 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: • - 1 - • Name of Contractor - Insurance Company/Policy Number.. - Name of Contractor - Insurance Company/Policy Number . • . - Name of Contractor Insurance Company/Policy Number - Q 1 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 dweiiint 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 Insuranri for coverage verification and that faiiure to iecure coverage as required under Section 25A'of MGL 152 can lead to the impoiition of criminal penalties consisting of a fine of up to S1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Srop Work Order and a fine of S100.00 a day against me. • Signed this Q'J day of ,ct4 - , 19 9' 3 ✓a �_ Li raseeeiPermiree' Licensor/Permit-tor