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Home My WebLink AboutBLD-93-676 i • '.*c-�° r o TOWN OF YARMOUTH 9l OO 4' c. (� �LJ 4 j MATT.:2HE Z r 670 mi �� <Wf.- Application for a Permit to Build No. it UPON FINAL APPROVAL. -4 o/- 3 , MAP 19 LOT 77q�,. FEE MUST ACCOMPANY THIS APPLICATION. ' DATE 3 19 9S `:I � The undersigned hereby applies fora permit to build `7/.3/93 accyrding to the following specifications 'T. Name of prope t�y ner %Ani A "Ea'./,y/ Tel.S7v aGS 'Address�8 Ga/tc c r CaecA , t.4. .r,f ineeni%/#74 c c6/ 2.Name of Architect(if any) �� / //�� a7 Tel. 14:Name of builder,4t ,% 4/i e74 e eil c�rZ 3ddrs Mia address/.?o 4.�'tat t'uvJld o.6. Saks 4. License No. OC151Ac Tel. 5. Name of Mason _Address 6. License No. Tel. ✓%Construction address AP Co/des erred, or. 6 ,roci 34, /inf.. 8. Date of subdivision Approval FloodL- Zoneeict g _,Yb pp zone plain 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE 10. Multi family 0 4en. If Type of room No. rr 11. Commercial 0 Kitchen 12. Other o Dining Rm. Living Rm. 13. No. of stories -too cro 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 F'X i0' Shed 3-)0 o / 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 / rom rear lot line Side line 25. H.I.C.R. No. /0 9 3 71 �� LOT RELEASED BY Signature I_ ' ' ' PLANNING BOARD A. •ress ad te �.r . 7 Date do✓',fr&v 2 /e'. tw; • TOWN OF YAMOUTH 40. BUILDING DEPARTMENT - -• -- - - _- - HOMEOWNER- LICENSE• ' . a !TION PLEASE PRINT: p DATE 4, /gee_ c?/ /95s JOB LOCATION d P C0ER s• ��E mod y naI NUMBSTREET ADDRESS ! SECTION OF,TOWN _ n - "HOMEOWNER" .Jo%/ 2%-wve/ ../0�-6.1. -T6sr .r''�4're- NAME `l HOME PHONE WORK PHONE • PRESENT MAILING ADRESS t!tot-.»� 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, PROVIDEDTHATTHE 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 WHIICH 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 FOILM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT HE/SHE SHALL BE RESPONSIBLE FOR ALL SUCH WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1) TILE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH THE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGULATIONS. THE UNDERSIGNED "11ONEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE ' WILL COMPLY WITH SAID " e - ""URES AND REMENTS HOMEOWNER'S SIGNA I ' 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 aeinsurance o liability insura ce policy or its substantial equiva!ent which meets the requirements of MGL Ch. 142. Yes If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability Insurance policy [FJ . Other type of indemnity 0 Bond ❑ OWNER'S INSURANCE WAIVER: I am aware- that the licensee does not have the insurance coverage required by Chapter 142 the Mass. General Laws, and hat my signature cn this permit application waives this requirement. Iyr Check one: Owner ❑ Agent 0 Signa:c:e ct Orr cr Owner s --- '1 Suggested Affidavit for Home Improvement Contractor Permit Application For Omce Use Only NAME/O,F CITY/I.OWN Permit No. I�AAT?)4/T14 ,iM 0.1CC �L Dote / AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.142A requires that the"reconstruction,alteration.renovation.repair.modernization.conversion.improvement,removal.demolition. orconstruction of an addition to any preexisting owner-occupied building containing at least one but not more than,four dwelling units....or to structures which arc adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other requirements. ,tom Type of WorbJ"4pf f Sim Est. Cost/of-oa Address of Work ciii7 (C e7 RS ( j CCM' ."� r*0� �- 441151 Owner Name: J 4,.i X /ktiet;if 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 _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 as the age t of the owner: 4 3-q3 ,.nuc 1093-7y Date •ntractor : ame ' Registration No. . OR: Notwithstanding the above notice, I hereby apply for a permit as the owner oabove property: "Mfg alA/ f 76. wa G/ 0 .1. tir Date - Owner Name Sr PLOT PLAN . , FOR LOT # ' Indicate location of garage or accessory building Additions with dashed lines . Sewerage disposal (cesspool) ® _ Well 0 • (lot /c`3' a ft. rear) I Abuttor's CI I Abutt Name IName Lot # Lot # D0 REAR YARD If this is a ..e..1Iftl • corner lot, 1 ft. • corn awrite in name writ of street. . I name 1 a . othe ) stree• • C • 4 SIDE YARD SIDE YARD • HOUSE • c FT: 0, . • 40 FT I) • • 4 % . • h t1 ' . • SET BACK - o ft. 1 (lot AMC"r2 ft. frontage) .• / a?, ch/peed, ace.... ... / / (NAME OF STREET) . > \/ • . . , • / \ -information / \ \ Supplied by , = ._ . e == — COMMONWEALTH OF MASSACHUSETTS: . . ._ -. - . C �. —_"—r - DEI`AK MEN'T OF LNDUSTRIAL ACCIDENTS _s ' • - 600 WASHINGTON STREET James Camooeu BOSTON, MASSACHUSETTS 02111 • comm:ss onet WORKERS' COMPENSATION INSURANCE AFFIDAVIT 1, TiVictrhn C k 1 one) -PWoC OC ac s � r Abra-'In (licensee/permittee) -- - - - - • with a principal place of business/residence an - - - - 120 Cor i- ioSS-cSn CO. S io'e of S . (City/State/Zip) - do hereby certify, under the pains and penalties of perjury,that: _ _ '-- ' . . an employer providing the following workers' compensation coverage for my employees working on this /lob. AeTi) A- 023.3616 s8 CA 4 - 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 .. t Name of Contractor Insurance Company/Policy Number _ 0 1 am a homeowner performing all the work myself. NOTE.PIeue 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 Accident? Office of Insurance for coverage verification and that failure to secure coverage as required under Section 25A'of MGL 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 S100.00 a day against me. ` � Signed ' day of ✓ 19 tS /•� lA � Licomet• Liccso /Permtao: