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HomeMy WebLinkAboutBLD-93-671 retti ste k� ,eo TOWN OF YARMOUTH q,,/g3 c —y, ` MIITTACM[ 5 J �,?..,..,,o!e Application for a Permit to Build No. 6 7v UPON FINAL APPROVAL. _;_ w I�a"� MAP 4 LOT •'• K",7 FEE MUST ACCOMPANY THIS APPLICATION. DATE 19 The undersigned hereby applies for a permit to build 4 93 according to the following specifications 9 1. Name of property owner Lo 11. AECo'-rCA t! /� � Address.% 9-pi-t '`a'LiA•A 2:NameofArchitect(if any) " '�'- ..r . .Tel. 3. Name of builder i _ a t1. 2 . .. . r:. , y address igen CoritS Tgx e bags' 4. License No. Tel. 5. Name of Mason Address 6. License No. Tel. 7. Construction address l 'Lt75 L.V.---' %ft4 n Flo C.-- District it_is-- 8. Date of subdivision Approval plain zone 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE Type of room No. 10. Multi family 0 I /owes _ 11. Commercial 0 c ,/ 0 A /d P. DD Kitchen 12. Other ❑ 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 0 2 ❑ ' Family Rm. ✓. Sun room 18. Swimming pool - Size %7- ' ". .-. • a Garage 19. Storage shed - Size 57" A' /n Shed / 20. Stove — Wood 0 Coal ❑ Alterations 21. Size of lot: No. of feet front a No. of feet rear No. of feet deep 22. Size of building. No. of feet front No. of feet side No. of feet rear 2a 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. i - � A LOT RELEASED BY Signatur:J. A# ► LGer i PLANNING BOARD i Address ci LIT' /-4/19rDate y -. y4RMdcf TOWN OF YAMOUTII BUILDING DEPARTMENT • IIOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE JOB LOCATION 1/4177z Lac �,.y44646i % NUMBER STREET ADDRESS SECT ON OF,TOWN "HOMEOWNER" NAME ?Sr-ace HO PHONE WORK PHONE • PRESENT MAILING ADRESS�� 4.77(..11.77 - � ARMn} -'`r Crl MA € d � CITY OR OWN STATE ZIP 0 E 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- • DIV IDUAL 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 "HO.MEONNE•R" SHALL SUBMIT TO TILE 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 TILE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGULATIONS. • TILE 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 PROCEDS aik QUI' a ITS. ME �i.. �. l� � HOMEOWNER SIGNATURE ��Jllltalk''''' 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 cure�n.,t/�'bilicy insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes W No ❑ If you have checked ve.is, please indicate the type coverage by checking the appropriate box. A Rant/ Insurance policy 0 Cther type of indemnity 0 Bond 0 OWNER'S .INSURANCE WAIVE:I: Iam aware- that the licensee does not hwe the insurancecceracn required by Chapter l ''' cf t. as-. Ger rail Laws. and that my signature cn this permit application waives this requirement. 4111 •Seasent^j Owner P Agent ❑ i;77,.. c, Cntcr cr L era 11-1.,!:... __ — — PLOT PLAN . . • FOR LOT If • • Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) e _ Wa11 or • I • (lot ft. rear) Abuttor's co I . Abul Name Nam- Lot n ' ‹,6.1---5rill I • Lot n ', REAR YARD - • • If thisisa Ift corner lot, 1 ft. corn write in name 1 � . wri of street. ,• _.. • Ja _ name ,; a .•othe •pC7 aoi sire ro • SIDE YARD . SIDE YARD • HOUSE • FT. r\ . . /i FTQ 4 • • • • I " � • SET BACK • • o ft. 43 a I _. I (lot ft. frontage) .. \ / (NAME OF STREET) \ / \ -Information AS Supplied by Litt 4. 0 / \ • , Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only NAME OF CITY/TOWN Permit No. Date AFFIDAVIT Home Improvement Contractor Law • Supplement to Permit Application MGLc.142A requires that the"reconstruction.alteration,renovation,repair,modernization.conversion.inprovement.removal,demolition. or construction of an addition to any pre-edistine owner-occupied huilding_containingat 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: 5/{; Est:Cost -70:1472) Address of Work 91:6J774. Lu f —j\/,iRet Owner Name: / l �.—rA4/1 • Date of Permit Application: l�/99 I hereby certify that: L t� Registration is not required for the following reason(s): - _Work excluded by law • _Job under 51,000 uilding 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 "0 c. 142A. Signed 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_v appl • or a permit as the owner of the above property: A � anat r��ea �� Dat Owner :Came • ti I , ;` „ . _:„. ` COMMONWEALTH OF MASSACHUSETTS Iii: = a DEPARTMENT MENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET Dames Campoe; BOSTON, MASSACHUSETTS 02111 . Commissioner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • I, CeKTE-441 (licensee/permit-tee) • with a principal place of business/residence at., �! 1? 'r La - 7 / . (Ciry/S tc/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. ( ) I am a sole proprietor, general contractor oZmeo?(circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: •• • • Name of ContractorInsurance 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:.Please be aware that while homeowners who employ persoos to do maintenance,construction or repair work on a dweiiirg 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 bomeowoer for a license or permit may evidence the legal sums Olin 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 Insurance for coverage verification and that failure to iecure cove rage as required under Scrion_'SA'of Ma 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 dtti penalties in the form of a Stop Work Order and a fine.of 5100.00 a day against me. Signed this at. day of i7j-0/119 � _r.s . L..nso::P:rmi