HomeMy WebLinkAboutBLD-93-684 / : - - /
%�;.oF YA, 9`8'43
, 4t- '61ey TOWN OF YARMOIU,TH A � ?/.r`!4g
Y- t t . 4' f 41
I
,,"kms��50.- Application for a Permit to Build No. `!
UPON FINAL APPROVAL , '/ 1,213 MAP S/ LOT K/0
FEE MUST ACCOMPANY TI-US APPLICATION. DATE 9..: •
The undersigned hereby applies for a permit to build 7 r 7
according to the following specifications , /
1. Name of property owner RAy,oN . t4 CAS ZINO Q . ��el.399 Ju9a.
Address '0 DhW,t/(/ PhM , tdyARPrOvr•!t/MA
2.Name of Architect(if any) r �� t �) Tel.
3. Name of builder IQAyM•Am I/' £ S?ANO St Address023 372lc /'nth o
4. License No. 00.2 93/ Tel. 390 02 115‘ (994 —36,51 tR✓c' )
5. Name of Mason Address
6. License No. Tel.
7. Construction address 40 DAN 19 c P9-rL
8. Date of subdivision Approval ///a/?/ plan District
�� plain zone G Zone
9. Private dwelling Estimated Cost` DO NOT WRITE IN THIS SPACE
aag p, — qi,-L I Type of room No.
10. Multi family 0 t5tb091 - P'11. Commercial ❑ _. ` a Kitchen
Other ❑ / int-
12. £XI57 av &-g., Dining Rm.
a �XI57-nyr
Living Rm.
13. No. of stories
Ws- 0-s Bed Rm.
14. Foundation — Full 0 Half Crawl 0 Slab 0 /Q,-� ate Bath
15. Materials — Wood if Cement 0 Other 0 3 fit 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 • --, -, `, r.:/i, : Garage r
19. Storage shed — Size Shed
20. Stove — Wood 0 Coal 0 Alterations
21. Size of lot: No. of feet front /CO No. of feet rear in No. of feet deep //0
22. Size of building. No. of feet front P No. of feet side o/`{ No. of feet rear R
23. Distance from nearest building: Front Ft. side 53 Ft. side 0 Rear 80
24. Distance back from line or street y0 ' From rear lot line 99 Side line 3/
25. H.I.C.R. No. 10529l171 //
LOT RELEASED BY Signature l '
PLANNING BOARD Address 623 %LLS 47--
Date L,/.pMinet. 0en-4i ,4. Al 4 93
- /inn,PERMIT APPLICATION SIGN OFF
• •• li� . -- -`
AP,PLICANT: &,J/J't(Nb I/ / S/,}/4/c'7 gr. BUILDING PERMIT 1/:
ADDRESS: %JfO D/;A//}s 44 . • . TELE. .NO. : t3 4-lgy,2 DATE FILED: f 243
j'') ` � / f
1 + �'j',,!• ' t 4, + � LOT//:
BLDG. SITE LOCATION: 90 (/p/vA9 5•r1r� . i�AP#: l7 /
/ AVL r •..! i. /�. f- - -
THE FOLLOWING INFOR'ATION OUTtINES'THE•P`ROCEDbPAL STEPP 4I EQUIRED' TO OBTAIN ArE.ERMIT TO BUILD,
ALTER, OR ADD TO A STRUCT)RE,WITHIN,THE TOWN. OF YARMOUTHf..rTHE BTTJ.DING, pEPARTMENT.WILL DETER-
MINE COMPLIANCE TO THE FOLWING'"(A)'ONING/RENIRESIENTS .(B) HISTORICAtDIiRICTS (C) FLOOD
PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR AS�'UI1G THE APPLICANT THOUGH
THE FOLLOWING DEPA�tTMENTS? - !!,
+: ,.> C i I t°�3 1 ,k tot. RES117ENTIAL4 1D/ORE COMMER�C'I'AVAli LDING
WATER DEPARTMENT: DETEP SS,COMELIANC$(OF , AW TER AXA;IZ#1IiI T.TY.
ENGINEERING DEPARTMENT: DETERMINEpAQMp.�ANCE$ 'qR P4RKI.7G IANu.D IN jGJ , ---- . _ - --
CONSERVATION COMMISSION: DETEIUIINES CO13PL MCL' TO tIETr.ANDS' E&OTS, I ! : IF LOT(S) BORDER ANY
TYPE OF WETLANDS, STREAMS,r( PONDS, RIV)E2RS, OCEANS, BOGS, BAYS, MARSH .
�1 E E , r.
S TOWS RECTTtA ONS
' �JlAND.f` 11. _f
HEALTH DEPARTMENT: r5 6 NT§ SFORSSEPTAG liISPOSAIITAQNtT t4V.PU,BB1eCR n�.T$•.ACTIVITI, I.E. : �QUIRE-
FIRE DEPARTMENT: ., DETERMINES COMPLIANCE TO STATE AND TOWN REQUI• mi NTS FOR PERSONAL
SAFETY, PROPERTY PROTECTION, I.E., SMOKE DETECTORS, SPRINKLER SYSTEMS,
' ETC.
// /� ,a_
THE FOLLOWING DEPARTMENTS MU 'S -8IG`T'OW,AN T'ORESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR
ISSUING THE REQUIRED BUILDING PERMIT./
el
REVIEWED BY: • .$
1. WATER D 'PARTMENT4%,*,.., ./ • ,'9, ,,,:-SC" DATE: ' - 3-93 N/A:
2. ENGINEERING DEPARTMENT: r- / DATE: N/A:
3. CONSERVATION: "i/.n ` //1 DATE: N/A:
4. HEALTH DEPARTMENT / JJ,{ . // - L DATE: "— 7-V 3 N/A:
IDP�US IAL AND/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR: , DATE: N/A:
6. PLUMBING INSPECTOR: (/ DATE: N/A:
7. FIRE DEPARTMENT: DATE: 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. p
COMMENTS: ./.`.,Cc/—. /7✓ -.-12,-+/-; /J71/ ,-7%,,i 5 L✓,yair G Dll O � ✓tCom
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BLM/89 • -
• BUILDING DEPARTMENT •
CONSTRUCTION SUPERVISOR FORM
•
•
LEASE PRINT: ' • r , .•
OB LOCATION: O. '
NUMBS . STREET VILL E �
WNER OF PROPERTY: ' I4y ONO ti 1,41. 0/QA/DSe. it
ONSTRUCTION SUPERVISOR::: /J/-r MoN,D s Casae j' : 414
ONSTRUCTION 23/ ,Sty_021?y
• 11 • �� A,ME LICENSE NO. PHONE NO.
)DRESS: ;2,5 H(.1/1/1S %fhb V,JSgn ! 4 "ii)
ICENSED DESIGNEE:
IF OTHER THAN SUPERVISOR) ) NAME LICENSE NO.
iii .1
.15 RESPONSIBILITY OF EACH L±C NSE HOLDER:,
itc. ,"n ill • • t • • .' i.
.15.1 THE LICENSE HOLDER}SHALL, BE FULLY AND COMPLETELY RESPONSIBLE FOR• ALL WORK FOR WHICH HE
S SUPERVISING. HE SHALLO BE'.,RESPONSIBLE FOR SEEING THAT, ALL WORK IS DONE PURSUANT TO THE STATE
' UILDING• CODE AND THE DRAWINGS •AS AP?ROVED' BY THE"BUILDING OFFICIAL
7.15.2 THE LICENSE HOLDER SHALL BF/'RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION,
ALTERATION, REPAIR, REMOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING
\ND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE
O:LMONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB—
ONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER.
• .15.3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE
ISCOVERY OF ANY VIOLATIONS <rHICH ARE COVERED BY THE BUILDING PERMIT.
.15. 4 ANY LICENSEE WHO SHALL WILLFULLY VIOLATE SUBSECTIONS 2.15.1, 2.15.2 OR 2.15.3 OR ANY
THER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL 3E SUBJECT
0 REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. .
. 16. ALL BUILDING PERMIT APPLICATIONS SHALL CONTAIN THE NAME, SIGNATURE AND LICENSE NUMBER OF
. E CONSTRUCTION SUPERVISOR WHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION," RECON—
TRUCTION, ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.1 OF THE
ODE AND THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISING
AID PERSONS, THE WORK SHALL IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED
N THE RECORDS OF THE BUILDING DEPARTMENT.
HAVE READ AND' UNDERSTAND MY/IZESPO:NSIBILITIES UNDER THE RULES PND REGULATIONS .FOR LICENSING CC'
TRUCTION SuPEFtI'tS,OES: IN 4GP,i,NCE :.:/m SECTION, 109.1.1 OF THE STATE BUILDING CODE. I UNDERST _
HE CONSTRUCTION INSPECTION P;OCEDCRES AND`.TBE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDIN
.FICIAL. ' ,• '
INSURANCE COVERAGE: •
I have a crrre I ..ity insurance policy cr its substantial equivalent which meets the requirements cf MGL Ch.152
Yes Cr Na 0
. It you have checked yes. plea__ inci=te the type c:.eragc by checking the a.c.:_riat_ tax.
A liability insurance pc:icyC�T Cher type ct '. cemn ty ❑ BcnC 0
CWNE:R'., tNSL'RANC: WAIIVVER:'I 2, aware that the ccensee Haes .t t•wP the in_,.,_,.__ ccve¢;e rec_:rec
C:72:::2' 52 tt the Ma_ G r_: .,s. an ...et my sic a•ure cn perm.:: _ :ica,cn waives this requirement.
•
C'. Check cne:
+r.er_
Agent etre —
E..^yr.alL'ra C.Aner of 0,.ner s AyaOl
Suggested Affidavit for Home Improvement Contractor Permit Application
For office Use Only t e NAME OF CITY/TOWN
PermIt No. .• / • _ •• , ,. '. i 'y - ,
Date `
? • , . .!, • AFFIDAVIT; • , ,
.-.) f Home Improvement Contractor Law
�/1 f's•t, :,�` ` Su lement Application
e ., r.•. '.� ,PP _ to Permit A
) 1 // : ,
"s MGLa 142A requires that`t he reconstruction.alteration,renovation.repair,modernization.conversion.inprovement,removal.demolition,
orconstruction or an addition to any pre-existing owneroccuoied building containing at least one but not more than tour dwelling units....or
to structures which are adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other ,
11 1 regtnrements. ce •i ; r •t , t
Type of Work: V.D/ ' /Q/(/ Est. Cosi.e000en
—
Address of Work 410 ,)4Nhs 4 te4 UJ7A/,�,+gave4 ,nA 1
Owner Name: ekyf i,41 p d� 4s/r9N0 SC .
Date of Permit Application: lye in
1 hereby certify that:
�,i'Registration is not required for the following reason(s):
1"
_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 ap ly for a permi the ac t of . 1,w.
yes f3
D to Contract. Name Registration No.
OR: • •
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
Date t - Owner Name
; e
•
s E _
r. __ ,- COMMONWEALTH OF MASSACHUSETTS't .
3 _ • DEIAIz:MENIOFINDUSTRIALACCIDENTS -
•
600 WASHINGTON STREET
James J Camvoel; BOSTON, MASSACHUSETTS 02111 •
ommsslonet
Qp WORKERS' COMPENSATION INSURANCE AFFIDAVIT
A A40/fs'D /1 &S Zc'o J .
(licensee/perm ee) ,;
• with a principal place of business/residence at:
023 J0E(s At-4. , M./ .touiA f 1n A t oak 9.3
1 : (Ciry/Sore/lip)
do hereby certify, under the pains and penalties of perjury,that:
'It.' - -
( ) 1 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.
( ) 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: ---•••• •s -••
, ' ,•
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_.Pleasc be aware tiativhile homeowners.who employ persons to do maintenance,construction or repair work on a
g
dweiiinof not more than three unt:a in which the homeowner oeoner 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 Acddend Office of Insurance for coverage
verification and that failure to:mire coverage as required under Sea on '_5A'of 1v1G1.152 can Icad to tie imposition of criminal penalties
consisting of a fine of up to 51500.00 and/or fnofuogment oft p to one year and civil penalties in the form of a Stop Work Order and a
fine of S100.00 a day aainst me. f ' r ,s . • td . .y--
41-41
Signed this 04/
' day of 4��/ 19 73
tall Ilk
'icense::Per. ,.__ ii......sor;P:rmrr,or
. PLOT PLAN .
FOR LOT # E/0. /OA/ ‘r 7
Indicate location of garage or accessory building
Additions with dashed lines .
Sewerage disposal (cesspool)
Well
5
. //11-;-, ,'-' .< 'x (.? .J�. ' . . t - j
(lot /S ft. rear)
Abutto .
ids� ''J + L) /". i i 0, , Cori , ' i . . ,' ; ;') • . Abul
Name I Nam
Lot I -- Lot n
REAR YARD
If this is a •
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corner lot, . . . . . . . . . .ft. • corn
write in name . wri
of street. I -. name
i; • • • •
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SIDE YARD . SIDE YARD
�7 • HOUSE
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/ • Information c / X_s i to
• / \ Supplied by KK /Y
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1.)-.ALL. WORKMANSHIP /CND -'_MATER,/ALS i ._-_ ,•
S//ACL ',&E .ACCORDING-TO_-PROVI.S./OIJ S-OF
:o. E. Q. E. TITLE-. 5 _.AND-_.T�JF -TOwAcor::_:
_y2rem 00TN RULES AND REGULATIONS .
:FOR SUS SUR P,R CE. DI sae)sac. -OF-__:__. -._-
_SFih'/rARY SELVAGE: __— ---- --- - ----
.2. THE REGISTERED SAN/TAR/A/:/ .WHOSE='
_ s7—,c)/4P-A"P_PEARS__ON_T_HE_.S-E=DRAWJNGS _- - . -
=-Ski?LL SE RESPONSISLE ' FOR' j79'E'
S UPERVI SI ON AND :CERT/FI CA77ON OF •
. CON STIRUCT/OA/. /N. STRICT ,9 CCORDANCE_
2WITI- ._THESE PLAINS J LVHEN�APPROVE,, '. . :_
T. .6Y_THE ..GOVER/WA4Q,/SO:9R0 0r /HEALTH,
-s) EXISTING GRADE RND FIN/SHED
. GRADE WILL ..1-3E ESSENT/ALCV THE �,. "' "'�
_. - - `-%0.0 OF 5.,,�, mieN LEG45 ING SPEE�VATONS'_ 00- 1VffY2'
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EXISTING CONTOUR - - -0- - - 4‘11,� ��SURyEyO
FINISHED SPOT ELEVATIONS 0.o , Skye;;;•% � , ' '
FINISHED CO/./TOUR o-- ''k hl ' -
APPROVED: BOARD OF HEALTH CERTIFIED PLOT PLAN /N
Y.9.RMo/ Tb/; MASS.
DATE AGENT 1.r/T /o - OAn/A 'S PA TN
.7- CERTIFY THAT THE PROP O'.'ED RIC;/ARD J. O'HEARN,R.L.S., R. S.
till;LDING SHOWN ON THIS Pt .9N /91 MA/N ST (RTE. 28)
CONFORMS T.o THE ZONING LAWS WEST DENNIS, MASS. ,
OF Y.`/RMOUTH "MASS.
• DATE //J26/27 I SCALE: /"= SO '
_V26�7 7 �� /_ IJUf? A!O'- ___' _ 1 CLIENT:CDASTAN O%
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CERTIFIE' PLOT AN /N " ;< 'wi
f•t MOU7"H , MASS. ; tir„
Lor n/0 Z2A,/A IS I-7-',":'' -i -I
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I CERT/FY THAT THE FOUNVA flOki RICHARD ✓. O'HEARN, R.L.S., R.S.,' -;,'
S- WN ON THIS PLAN IS LOCATED /9/ MA/AI ST. (RTE. 28) " 1,;;
ON THE GROUND AS /ND/GATED AND WEST DENN/S , MASS. - -`•t;'H"," ..
CAA/FORMS ' TO 'THE .20N/NG LAWS e. r, r ;-'::,;' w+
of YAR/�O✓rH , MASS. ' _ DATE: i2./i. ; �7 SCALE: r0 , _, ' ;,°
;„ ., JOB NO. -Obe • CLIE/d/'t `jA5-rAn 0 ;'kt =r.;
Sr4 7 REG. D SURVEYOR- DR.' $Y RE SHEET ��• / ::;. ;5-
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