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Home My WebLink AboutBLD-93-682 YAkA ' � '> o TOWN OF YARMOUTH Orr?' to �i H �j (x7 R Iwn es,,le 9O.% Application for a Permit to Build No. UPON FINAL APPROVAL rye) / .$ MAP / LOT X l 9. FEE MUST ACCOMPANY THIS APPLICATION. \ DATE Se 9-. P 19 93 The undersigned hereby applies for a permit to build I 9..3 according to the following specifications 4J/e93 \1. Nameofpropertyowner Ch&r)' s Gzttihb1 'e / TeI.39$=ao9C \ Address /3 Geor3 e-fowh 1h ///0i- IZcd, 2.Name of Architect(if any) Tel. \3. Name of builder C}) ‘ Y les Ca 1 e Address l i ctn.; e"+'ow b AMIMI RA . 4. License No. Tel. 5. Name of Mason Address 6. License No. Tel. \ 7. Construction address 15 GeoYd etotJ 1 & vd)n .' RoaA . Flood District 2_ yo 8. Date of subdivision Approval plain zone C- Zone 9. Private dwelling ® Estimated Cost ==-119 NOT WRITE IN THIS Type of roomSPACE No. 10. Multi family 0 \ Li /,o°° ,oonJ1ot -7J I / 11. Commercial 0 57R/191 Pc/-12/r/1 t J/ Kitch n 12. Other 0 a.. r—�a-ab/r *etc Dining Rm. 13. No. of stories i Living Rm. Bed Rm. 14. Foundation — Full M Half 0 Crawl 0 Slab 0 Bath 15. Materials — Wood IM Cement 0 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 ❑ 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 From rear lot line Side line 25. H.I.C.R. No. LOT RELEASED BY \ Signature c-RA-N-52-12-0 -c PLANNING BOARD Address 13 G ear: Clot.- h J )ct/hJ k J Date \ Sn�-/-ti y u-hies-i-h • I • � COMMONWEALTH OF.MASSACHUSETTS _' e• • • DEPARTMENT OF INDUSTRIALACCIDENTS 600 WASHINGTON STREET tames Camooeu BOSTON, MASSACHUSEI IS 02111 • Comnss one• WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • • � I (licensee/permi aee) • with a principal place of business/residence at: (City/State/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 sok proprietor and have no one working for me. • [ j 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 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 dweiiing 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 virus 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' Of ice of Insurance for coverage verification and that failure to iccure coverage as required under Section 25A'of.'vfGL 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 this e% o Uu4 / ?Q �9idayof Sep7E. , 19 93 Lice .so:,. crmt;:or • • 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 MGLe.142A requires that the"reconstruction.alteration.renovation.repair,modernization.conversion,inprovement,removal,demolition. or construction of an addition to any preexisting owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or budding"be done by registered contractors,with certain exceptions,along with other requirements. 1 Type of Work: (R �-/'�2ce )•oa � SJ� ih,��-e5 // Est. Cost �� aaa .eo Address of Work 15 Geolg �� awl Lk), d. lhq- IZq, SoLCIJ YeaMou--P) \ Owner Name: CJ at/ -s G& rr\ • b � � ' \ Date of Permit Application: ,Se'51 a 7 9 93 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under $1,000 Building not owner-occupied XOwner pulling own permit _Other (specify) • Notice is hereby given that: • OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ' ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: • Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: 1993 e L.a o ideurrjrQk Date Owner Name .�' TOWN OF YAMOUTIH BUILDING DEPARTMENT I HOMEOWNER LICENSE EX.EIPTION PLEASE PRINT: DATE Sep/• 2 199_3 JOB LOCATION 15 C toy/ e 7o w h Lz , d h g 424. SoiC14 yak-mock-I-1, NUMBER STREET ADDRESS SECTION OF;TOWN \"HOMEOWNER" C-A 2c_ tes G- -4241b)e 398- 207 C 6/9-75 - S,?•6 0 NAME HOME PHONE WORK PHONE PRESENT MAILING ADRESS )5 CeotfQ 9-ow h L$ hd/n7 12s( • Sok-fh tfxrh-joh MASS, aa6 69 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 WIIICII 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 14110 CONSTRUCTS MORE THAN ONE HOME IN A TWO-YEAR PERIOD SHALL NOT BE CONSIDERED A HOMEOWNER. SUCH "HOMEOWNER'? SHALL SUBMIT TO 111E BUILDING OFFICIAL, ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT HE/SIZE SHALL BE RESPONSIBLE FOR ALL SUCH WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1) THE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH TUE 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 PROCEDURES AND RE•QUI• aiNTS. \ HOME•OWNER'S SIGNATURE C-14252-12.0 - --Q 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 current liability insurance policy or its substantial equivalent which meets the requirements cf MGL Ch. 142. Yes ❑ No NI If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance pciicy ❑ Other type cf indemnity 0 Bond 0 OWNER'S INSURANCE WAIVER: I am aware. that the licensee dces not have the insurance coverage required ny Chapter 142 cf the Mass. General Laws, and that my signature cn this perm' applicat`.cn waives this requirement. �" � ' CC '< cr..e: . .4/ (.Qo Owner Agent 0 Signa:are a G•nr.er cr Genera s _- _-_ —— •