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Home My WebLink AboutBLD-93-688 • 01' ' -'' ' :ita TOWN OF YARMOUTH oYE g/R(n: I Hi HV,,"4 .5.12 Application for a Permit to Build No. €4a UPON FINAL APPROVAL ��oh3 MAP eft _ LOT F-/ FEE MUST ACCOMPANY THIS/APPLICATION. DATE - 19 The undersigned hereby applies for a permit to build 9/ro according to the following specifications /i 9� °193 1. Name of property owner T .. Ctor 'LT) Tel. Address / � �-ic4ctr.t-cute 2.Name of Architect(if any) Tel. a Name of builder Hn r( eus4A-o,. Address 76 Stirre/Ir/e..ei ,PA 4. License No. 63S39c- Tel. -S-6 C---4 rtl - 13 93 w. WcrehA+"- 5. Name of Mason Address 6. License No. Tel. 7. Construction address /,t.r[1',.A Crnie Flod o fer--.n,•,.d'- 8. Date of subdivision Approval plain zone G DistrictZone _ -Z 9. Private dwelling 0 Estimated Cost DSO NOT WRITE IN THIS SPACE 10. Multi family ❑ y 6 e60-ed Da, /a o-�. Type of room No. / d tr(tH9/4-no/S 11. Commercial O q 3 - Kitchen 12. Other ❑ S; U-0 Dining Rm. d5C13. No. of stories l : ;, Living Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bed Rm. Bath 15. Materials — Wood Ir Cement 0 Other 0 c rr-r�SEP Deck � 3 a .a-o BBQ 16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 0 2 0 Family Rm. Sun room 18. Swimming pool - Size Garage 19. Storage shed — Size Shed 2a Stove — Wood 0 Coal 0 Alterations !rC 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 2a 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 ..,,61/,.4��-•— PLANNING BOARD Address IC 5.,�.,,-13/ ,te Date ki It,a.,tle,., /-14 sr g 9/x193 _ -_ _ _BUILDING ,PERMIT APPLICATION SIGN OFF AP,PLICI T: /w f , ). (Sr.. /1 ',Sf" 'rn BUILDING PERMIT 1/: ADDRESS: / G cle • Var%na��A TELE. NO. : 3I`/V37/ DATE FILED: ilc.,4) BLDG. SITE LOCATION: / 4t,...„-Ann f cc�•o (/a .novAk MAPA: 6=r� LOT4/: L' � 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: DATE: N/A: //HEALTH DEPARTMENT 4.4 (Ilt /y] . DATE: y/03 N/A: INDUSTRIAL lYND/OR COMMERCIAL PERMITS C5. WIRING INSPECTOR: p DATE: SEP 7" 1993 N/A: 6. PLUMBING INSPECTOR: DATE: N/A: £/• ✓/. FIRE DEPARTMENT: great) DATE: 9/.5/,3 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. COMMENTS: 4E0 - A. c1�w - i"U 4<. /)LAM,h,1 of "i•Cok- Y ICC C,. 5'n4Z11/3te ArC 4J Nesj BLM/89 944e-1419 S i C` _ to COMMONWEALTH OF MASSACHUSETTS ti, DEPARTMENT' OF INDUSTRIAL ACCIDENTS \L f 600 WASHINGTON STREET games J CamDpel BOSTON, MASSACHUSETTS 02111 • romm ss ones WORKERS' COMPENSATION INSURANCEAFFIDAVIT AFF�DAVIT IY HcrR (,ter F it — �iq AA," ///,,,t Sirci' "7.---- (licensee/permittee) • with a 'ncipal place of business/residence at: 7 cf-,.,,,r4. i 23/,—A geA fit/ 4f ti re 1---- (City/State/Zip) do hereby certify, under the pains and penalties of perjury, that: [) 1 am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number [ I am a sole proprietor and have no one working for mc. • [ ) 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: -.r , • . -• ._ ••• Name of Contractor . Insurance Company/Policy Number .. . ..- ., . Name of Contractor • Insurance Company/Policy Number ..• - Name of Contractor - Insurance Company/Policy Number 0 I am a homeowner performing all the work myself NOTE:.Pleue 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(GL C. 152.sec 1(5)),application by a homeowner for a license or permit may evidence the legal sums of an employer under the Workers' Compensation Act I understand that : copy of this statement will be forwarded to the Department of Industrial Acddents'Office of Insurance for coverage verification and that failure to s'ecure coverage as required under Section 25A'of MO1. 152 can lead to the impoiition of criminal penalties consisnng 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 5100.00 a day azainstme. C� G� • Signed �rhis n'.9;---/L,...........7day of 7 , 19 / 3 V 16, of yr. • so:;terms TOWN OF YARMOUTH • BUILDING DEPARTMENT ` ✓ CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: . ' . • JOB LOCATION: 7 '/) tef re-Vt Cite , • C, 7;-. O k/7-7 NUMBER . VILLAGE OWNER OF PROPERTY: ' ' /Q!i!7 6-22,0:6.0yf CONSTRUCTION SUPERVISOR: • ,24, f /l • CYC 5 Td Say 03S' .54P-i0/-7.r93 NAME . /LICENSE NO. PHONE NO. • • ADDRESS: 7 ;ierc�(✓ �. Z.4. Z) ire 10. /4_2i4%Zc#-*V'n - LICENSED DESIGNEE: ' . ' • (IF OTHER_THAN SUPERVISOR) NAME LICENSE NO. • 2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: ' ' 2.15.1 THE LICENSE HOLDER SHALL BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE • IS SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE 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, 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 • COMMONWEALTH, EVEN THOUGH HE, THE LICENSE 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 VIOLATIONS WHICH ARE COVERED BY THE BUILDING 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 AMENDED, SHALL 3E 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, ALTERATION, REPAIR, REMOVAL OF DE!OLITION 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 L`_'MEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED • ON THE RECORDS OF THE BUILDING DEPART".ENT. ' ' ' ' • •. • • I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR LICENSING CC:I- STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERST?_C: THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. . ,. _ . . : • . INSURANCE COVERAGE: ... . . . . • . _ _ , „ ., • • ' • :. .7n. nt I' I have a curreility insurance policy or its substantial equivalent which meets the requirements of MGLth.152 - . . Yes ', No ❑ If you have checked yes, please inicate the type c:verage by checking the appropriate bcx ' :' I' - A liability insurance pc:icy t!d Other type of :.ndemnity 0 Oond 0 • - - - ' OWNER'S INSURANCE WAIVER:I am aware that the ccensee ace!: rret have the insurance coverage requirec tic Chapter1 of the Mass: General Laws, ana tha: my signature on th:s permit :critication waives this requiremer..t. . :. • • Check ore: • n„ .4;4404�-.� Owner•,=t Agent 0 Signature c Ower cr Owners Agent SIGNATURE: f.._ 70BUILDING OFFICIAL APPROVAL: ~ • BUILDING DEPARTMENT . r,.. - - - - ' -CONSTRUCTION SUPERVISOR FORM _ • LEASE PRINT: ' / ' / / OB LOCATION: ` • j , „r le / 4 .. // • NUMBER . STRE VILLAGE - WNER OF PROPERTY: ' -rem • 4 rr„sr 11 ONSTRUCTION SUPERVISOR: • HorX 4 bf_fr Aor - 635371 Sok; 91—,3 93 -7/- NAME LICENSE/ NO. PHONE NO. / DRESS: y� S • • �otrir/ _T�S /c,a eel kJ: to•ar�P/n ICENSED DESIGNEE: . • • IF OTHER THAN SUPERVISOR) NAMELICENSE NO. .15 RESPONSIBILITY OF EACH LICENSE HOLDER: .15.1 THE LICENSE HOLDER SHALL, BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE S SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE UILDING• CODE AND THE DRAWINGS AS APPROVED BY THE BUILDING OFFICIAL - . 15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION, .TERATION, REPAIR, REIOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING ND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE OMMONWEALTH, 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 IMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE ISCOVERY OF ANY VIOLATIONS WHICH 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 'LEER 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 .HE CONSTRUCTION SUPERVISOR WHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECON— "TRUCTION, ALTERATION, REPAIR, REMOVAL OF DE?IOLITION 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 DEP RTMENT. HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS .FOR LICENSING CC" :RUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERST : _.-.E CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING FFICIAL.INSURANCE COVERAGE:COVERAGE: • I have a current iab:ity insurance pclic/ cr is substantial equivalent which meets the requirements ct rdG'_Lh.152 Yes Ho ❑ It ycu have checked yes. ;:'ea__ inc.,.._._ the type c:vera,e by checking the __t..,_riat_ tax. 7 , A liability insurance pcccy 5� C:.`.er type ct :..cernn:ty ❑ Bcnd ❑ • ❑WHEW., I?JSURANCE WAIVES: I am aWare that the t:censee a L- ^____ .^of bwP the insurance coveragere__:rec _ C:-.2:12r 152 ct the Mass. Generws. ant ..._t my . • ..re cn :,.: pe..,... cn waives this req- Check cne: bwnerCi :.Sen: 0 S.;r::ur0 c: t:wner Cr Osrer s Accnt _.,. .. r, h. . 4 1 ` . ,two: _ _ ._ _ -_ _ _ __ . _ . . -__._- ______._ __ ._ I •..-•::, ' 'aha, . : %4i r7 {�r6PoSecQ i +l h T^ /Ti .t C .:Ki_ .I IS .. - • 2xISf�nS — — -- ••;I."' ^R .tt,jTitK.BH ei P4 :.:>:l:_'.•.-. • • t ' _..m, i -I . '.l•. 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P01 fld r.f.p - •a.enn.l 11211 COMha4W!ALT11 DEPARTMENT orroue WITT I M...nb.Y :Ham canoes OP 0101flo ORTON PLACE C.e.,.paw c..,.n ga. OTASSAGIN10RTTO •osi'6 MA 12101 ears Moms LICENSE CAUTION E7WMTIONDATE CONSTR. SUP&RVISON FOR 06/30/1995 "0401 rrrtertir• 1TE 11C-NO. 'MEMpyrRI HTTHUM B RESTRIC11ON9 12!�/! THEFT.P,rT RICHT THUMB NONE 06/30I1993 035398 PFONTINA'PROPRIATE �( ss tr BOX ON LICENSE. 'ORUIRRELvI*LANOp_f0 BLASTINGOPFAATORs SSA 011-46-3285 IM WAREHAM NA 02576 E Mt)srINCLVOBPHOTO. E '' L' 1 1,4 1 ? ._ -a..al.lu.ara.EO..w.ala. AUG o t;.� HEIC3HT: 2 �' 6/30/1956 n K .m oaweaiw x.r er ,r J..: . MUMS.'� Y1y siXt`.w urt Na aa.miss ar seas U v♦ Thal. • 1.MI1/aMl MkP"iMQ�MTaL -Y,� �..•• otOfl o& 'jz rviouth • ' fir • -AtdtICS' Inc` _ Cl. Yl PEAr J ag ; Cut'r%15