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Home My WebLink AboutBLD-93-674 e o� Y : R ti ,. -Cir 3/15 k ` r )" TOWN OF YARMOUTH Hfek ; : eC .W i Application fora Permit to Build No. 4 75 UPON FINAL APPROVAL �� 3 "G3 MAP 3 LOT FEE MUST ACCOMPANY THIS APPLICATION. DATE cr..�. 92 19 93 The undersigned hereby applies for a permit to build 7/3/y'--5 according to the follow spg ficatiioont 73/93 Ct)N O 1. Name of property owner --77c, �a'g A0-I ,,P � �� - , Tel.a 9+e .2.71, Address ea o-f•..,,.fr• A 2.Name ofArchitect(ifany) Tel. 3. Name of builder •�.�Address et/ nee-ir/€% ALS 4. License No. es,.27 a.9 Tel. S'Sz1R 9S/7 5. Name of Mason _ Address 6. License No. 3 Tel. 7. Construction address nervir/c.,K.LSC'...-L-^e Flood District 8. Date of subdivision Approval plain zone L Zone �.,8, 9. Private dwelling 0 Estimated Cost 1/4--tur DO NOT WRITE IN THIS SPACE g.a M3 /qa/gType of room No. 10. Multi family 0 �.0� 000 � q� ,L,�y�o�vS 11. Commercial /.,G, oz X7/9-3 _Kitchen 12. Other ❑ Dining Rm. a ) p Living Rm. 13. No. of stories / i14. Foundation — Full 0 Half 0 Crawl 0 Slab V 6 d -o'O BaL Bed Rm. Bath 15. Materials — Wood Cement a'Other 0 Deck 16. Type of heat — Oil 0 Gas% 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 dL 21. Size of lot: No. of feet front *4 No. of feet rear No. of feet deep 22. Size of building. No.of feet front S'/i ' No. of feet side /00 ' No. of feet rear yD' 23. Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from line or street Are, t ' From rear lot line 75- # ' Side line 4'4 25. H.LC.R. No. �� //�� f� ' LOT RELEASED BY Signature ze/� PLANNING BOARD Address d-.�'7 Oa (""�/� 4 Date �.-)1 /to.� /Z.c'- I O a 3.3— i =o-e- � 1 z- 7 7/9-3'gt BUILDING PERMIT APPLICATION SIGN OFF APPLICANT: . �,y BUILDING PERMIT /I: 'ADDRESS: / i e,,At .1��, *4 nee TELE. NO. : 't 9-s-607 DATE FILED: 7 7j, l � O BLDG. SITE LOCATION:f�'� � MAP/I: 3 G LOU: 7 ! 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: 9 DATE: N/A: 4. HEALTH DEPARTMENT yt / Al DATE: 19-- 30-73 N/A: `f 'UST'IAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: - ' �,:ic DATE: AUG 3 0 1993 N/A: 6. PLUMBING INSPECTOR:. i - it DATE: 8-- /- y 3 N/A: 7. FIRE DEPARTMENT: ( ($ ��, / DATE: y,t371Z 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. �� Lie-H-7-s- 61) COMMENTS:*FEZ& ) EDD Cx/ r .5/ ANS �26r/N '( L4 t,nc /e-H-7 s' 6) ffKNc S ysral T CoDe ?) -TooIcc-r `.ac«, riEs go> /vz- /%5G/• c (JS E r 9/ 13 4- /6"--e-enr- • BLM/89 1 WC11 - • BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM . PLEASE PRINT: - JOB LOCATION: - - cent..., �� NUMBER STREET V %AGE . OWNER 'OF PROPERTY:: 7'7X /Ca)'.!' ..-.�wm • le ' oa�.7Z9 S�s�g�7 CONSTRUCTION, SUPERVISOR: `'- __' NAME r i LICENSE NO. PHONE N0. ADDRESS: , • LICENSED DESIGNEE: LICENSE NO. (IF OTHER,THAN SUPERVISOR) NAME 2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: 2.15.1 THE LICENSE HOLDER SHALL, BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WELCH HE IS SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO TEE 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, REIOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING S OF CAND STRUCTURES OMMONWEALTH, EVEN YTHOUGHAHE,TTHE HLICENSE HOLDERE STATE ,IGISONOT DE ATHE PERMIT ND ALL EHO DERR IBULONLE Y� THE A SUBCONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. 1.15.3 LICENSE HOLDER WHHL IMICH AREIATELY COVE•REDNOTIFY THETHE BUILDINGBUILDING OFFICIAL IN WRITING OF THE 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 &.MENDED, SHALL SE SUBJECT TO 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, ECONSTRUCTION, ALTERATION, REPAIR, REMOVAL OF DEIOLITION AS REGULATED BY SECTION 109 .1.: OF THE , CODE AND THESE RULES AND REGULATIONS. IN THE EVENT THAT 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. I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR LICENSING Ci::1 STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERST - THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BT THE BUILDING OFFICIAL. . INSURANCE COVERAGE: I have a current liability insurapce policy or its substantial equivalent which meets the requirements cf MG1th.152 Yes 0 . No 210 If you have.checked v`s, please incicate the type cnverage by checking the aocrccriate bcx. I A liability insurance pc:icy th , C:her type of :ncernnity 0 Bcnd 0 OWNER'S INSURANCE WAIVER: 1 am re that the licensee does ret have the insurance coverage recdrec v Chapter 15�2�Qf the� Mass. General L-w , ar tat my signature on th:s permit ac-:icaticn waives this requirerie^; �. ! /� /J : • C,1eck lice: Xt/cr �,,-e/� O'Nner� Agent S:gr.atnre or Cener lir Omer s agent E: BUILDING OFFICIAL APPROVAL: • • • __= ligl COMMONWEALTH OF MASSACHUSETTS • Pe DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET • James CampbellBOSTON, MASSACHUSETTS 02111 rpmm:ssioner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • 41/ (licensee/permi C Q • with a principal place of business/residence an (City/Stare/Zip) do hereby certify, under the pains and penalties of perjury, that: [ am an employer providing the following workers' compensation coverage for my employees working on this job. 12,5 r a l Mi° /3 .9/-2 2,c7, fon • 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 - • 1 • 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 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(CL 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 Insurance for coverage verification and that failure to accure coverage as required under Section 25A'of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to SI500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of S100.00 a day against me. Signed this day of J , 19 S l// T '(1, /� Lae- , LicenscciPermi ter' /' Licensor/Permit-tor