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HomeMy WebLinkAboutBLD-93-669 ,- -F:Ygk C re1b3 �`= kir s tri TOWN OF YARMOUTH :ATTACH[ 5 . 'r Application for a Permit to Build No. 6 b �'�° °•��' UPON FINAL APPROVAL 65-- `'4 —`3MAP / 0 y LOT 47 FEE MUST ACCOMPANY THIS APPLICATION. DATE Se et: I , 19 93 The undersigned hereby applies for a permit to build I /X19 5 according to the following specifications 1. Name of property owner JOI.To Tomotiara Tel. VAC 93 30 Address Il Keit �^�+ohet 'ltoe.eA Cl•.a-i-Lo.►+t 2.Name of Architect(if any) L Tel. a Name of builder McKe- V\e C 2�� D us 14Address 7 (,(✓NTS:6tow A o.e_ 4. License No. Tel. 35$ -7277 So✓tt YAhNrosfi- 5. Name of Mason Address 6. License No. Tel. 7. Construction address iCi 144. 'RotiL ya. Flood District n _9 O, 8. Date of subdivision Approval plain zone et Zone 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE J�par ©yeg- - Type of room No. 10. Multi family 0 A000, °O yl'��� 7-0 egp*,� LM T/„at 11. Commercial 0 4< t-oee or ro.a-- COD IL Kitchen 12. Other ❑ py.JS- oe°A-s Dining Rm. 13. No. of stories Living Am. SC; c-r) 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 Garage 19. Storage shed — Size Shed 2a 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 From re lot line ��_ Side line 25. H.I.C.R. No. lost 26 /// LOT RELEASED BY Signature � I PLANNING BOARD Address /7 D6&.q i's- 4d`4t Date c&k �y)~10►& • •. BUILDING DEPARTMENT. • ' - ' .. ` CONSTRUCTION SUPERVISOR FORM ' • PLEASE PRINT: ' .. . . • • • JOB LOCATION: ., l Wets 1r 4. • 4; NUMBER • • • . STREET VILLAGE • OWNER OF PROPERTY: ' TLS cul nwtV0..tti : \ CONSTRUCTION SUPERVISOR: M j 1c.t__ Kenoskey la 3c u JO.7a?7 NAME •. LICENSE NO. PHONE NO.\. ADDRESS: • Z 1) klohtlra,.C.of^ At'-G. . &wg ..".. 4015.4 \\ LICENSED DESIGNEE: v/ - (IF OTHER THAN SUPERVISOR) NAME LICE SE NO. 2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: NnaCO HQatE jf>,pppyEMENT IX TO Huntington Avenue • 2.15.1 THE LICENSE HOLDER SHALL BE FULLY AND COISLETELY RESPONSIBLE` FeitSco.rfoitt FORS C HE IS SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STAT 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, REMOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE .AND ALL OTHER APPLICABLE LAWS OF THE CC:MONWEAL:H, EVEN THOUGH HE, THE LICENSEE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB- CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. 2.15.3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE DISCOVERY OF ANY VIOL;TIONS WHICff ARE COVERED BY THE BUILDING PER` IT. • 2.15... 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 AMENDED; SHALL 3E SUBJECT TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. • .15. ALL BUILDING PERMI_ APPLICATIONS SHALL CONTAIN THE NAME. SIGNATURE AND LICENSE NUMBER O: THE CONSTRUCTION SUPERVISOR WHO IS TO SUPER:'ISE THOSE PERSONS ENGAGED IN CONSTRUCTI_N, HEN- STRUCTION. .ALTERATION. REPAIR. RE`:OVAL OF DEIOLITION AS REGULATED BY SECTION 109.1.: OFTHECOCl AND THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISI: SA:D PERSONS, THE WORK SHALL I:_^'EDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTE ON TEE RECORDS OF THE BUILDING DEPARTMENT. I -;VE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER T::E RULES AND REGULATIONS .FOR :ICENSING t STRUCT:ON SUP=RVISORS IN ACCORDANCE :;ITH SECTION 109.1.1 0: THE STATE BUILDING CODE. THE CONSTRUCTION I::S:__._ON PROCEDURES ANDTHE SPECIFIC :SPECTI LBUILD: OFFICIAL. I: ..ON AS CALLED FOR BY THE !BUILD:: INSURANCE CCVERACE: • I have a C'.^e.^.t a::i y insurance • 'W nsura a pc;ic; Cr s sub:.1n.:J ec_rra:ent whit' n- the : .:rer..erts of !.1CL`Z1,1$2 Yes No n � .._.. e: It you have c-cckcd_ ;:ease inc:c.:e :he:;,;e :=•;er_: ,.. _ _ ` _y- _� C�ec%Irty :�.. ___:_c:la:e box. A liability insurance p_:iy Crit Cher type et 'ncemnay 0 Bend 0 • C. :c. . .n _...._ .Ia.-. %antra L•..vs. _..c ..._. -y :n : :err.:�' __._nc: cc�e:c; u:Te;en. _ .d....4' ��A 'A. _. —. .c _ _ — 1. .:: _ •::A RE: /4///i . :.: S•iggested Affidavit fOr Home Improvement Contractor Permit Application . • • Foiomee Use Only, i .x AME OFSITY/LOWN •• . ' >, - Permit Nv o. !et -st BV . • •.D.4 AFFIDAVIT • • ' • Home Improvement Contractor Law .. . Supplement to Permit Application . • ' MOLe.142A requiresthat the"reconstruction.alteration.renovation.repair.maternirat ion.conversion.inorovement.removal demolitions orconstruction of an addition to any pre•eeisiineowner-oconied buildintcontnimne at lout one but not more than fourdwellineunlis....or - ' •to structures which are adjacent to such residence or hmld,ne"be done by registered contractors,with certain exceptions•along with other. • ' requirements. . .. i The of Work: 'RP lace �} 1 a-r�Ou•el Eat. Cost cg mea. .' .Address of Work I' .5-7 . wet; R . . r'/ee. 4fr,w•o...A • • • - Owner Name:' Ti) c�l OH.O act.w Date of Permit Application: ,/j/ 3 " 'I hereby certify that: • Registration is not required for the following rcason(s): , • _Work excluded by law • . • Job under 51,000 ' _Building not owner-occupied ' • • • _Owner pulling own permit _Other (specify) .. . .- Notice,ii hereby given that: • • " .'.OWNERS BULLING THEIR OWN'PERMIT OR DEALING WITH UNREGISTERED" t • CONTRACTORS FOR APPLICABLE HOME IMPRO VEMENT WORK DO NOT HAVE . •e •' ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL' ' • c. 1aza • Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: • Dat�j7 le tic (_'( SGC P/�,/ /d37.26 Contractor Name co,/,7, No. OR: - Notwithstanding the above notice. I hereby apply for a permit as the owner of the above propene Date Owner Name "' ilabiCcO ItOiis I$tIQVEbEPt1 Its:. :0 f it,nttnzfon Aveieute I ' • `"0 1116)l6 iMPNOVEMENT life. 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