The URL can be used to link to this page

Home My WebLink AboutBLD-93-689 1 ^.: /' ' � . '/13153 .rJ" Ale- �. `. 0 /4s; "T,t o TOWN OFyYARMO.UTH ‘ _ , . IAA iti Vie€,"k« 3 g At 1 Application for a Permit'to'Build No. . 619 - UPON FINAL APPROVAL 'V . 3 7/ MAP, ' ` ` LOT F 2- FEE MUST ACCOMPANY THIS APPLICATION. ;'"\ ' , DATE .ser'7. %9 19' `13 The undersigned hereby applies for a permit to-64d.�. _,. , r . ' ' 7/� 9� according to the following specifications a t16AJ " A. Name of property owner 1`'I I C. R A a t' (J 1/ 0 w L A rf D TelArt3 -.2G4-G?G7 Address 3 � to/I LLIR M slt big} r r iAvari Q Oret 2.Name ofArchitect(ifany) Tel. 3. Name of builder _Address 4. License No. t Tel. , 5. Name of Mason Address ' 6. License No. Tel. VC-Construction address /lb,2nwxc IY 4 ' 8. Date of subdivision Approval Floodizone 1 7 District I c3 9. Private dwelling fil Estimated Cost DO NOT WRITE IN THIS SPACE 10. Multi family 0 e' ,S^a o1, 00 Type of roo No. h� � �� • � n ' 11. Commercial ' q- � �� p�,.�� Kitctchen 12. Other ❑ �� ) , Dining Rm. 13. No. of stories / OJ � '-( Living Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 6.,;re-/ Bed Rm. COO p 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 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 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 " +-•-+-r')t./ ham• • ' PLANNING BOARD \ Address 2 1, 1;21. 4h Date ! t,J4.-LG.:_ , ei-. 0 G 4 9 i i I TOWN OF•YAMOUTII • BUILDING DEPARTMENT - IIOPfEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE 5cp7; / 7 /993 JOB LOCATION L1 U2 /7 i '1E 51', So. YF4ktvh. tiril NUMBER STREET ADDRESS SECTION OF;TOWN "HOMEOWNER" MRs', j24s.pM // ivLAND 026.3.'264- G367 NAME HOME PHONE WORK PHONE PRESENT MAILING ADRESS 3G,IIL.Lani 57: ---- A c L. iv -AcLj1v ra (2P �-7 , 66 V92 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 WHICHIIE/SIZE RESIDES OR INTENDS TO RE- SIDE, ON WHICH 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 111E BUILDING OFFICIAL, ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT HIE/SHE 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 UNDE•RSIGNE•D "HOMEOWNER" CERTIFIES ThL'1T HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE WILL COMPLY WITH SAID PROCEDURES AND REQUI' aINTS. HOMEOWNER'S SIGNATURE P9-4-1.9") ‘71. 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 cr its substantial equivalent which meets the requirements of MOL Ch. 142. Yes No ❑ If you have checked vis. indicate the type coverage by checking the appropriate box. A liabiEty Insurance policy tEq Other type of indemnity 0 Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required lsy Chapter 142 cf the Macs. General Laws, and that my signature on this permit application waives this requirement. . • Check one: C•,;r.er kg Agent r c: C'rcr er 0.+7. S nceHl • • '_ -'a COMMONWEALTH OF MASSACHUSETTS - - - @ DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET James Campoeu BOSTON, MASSACHUSETTS 02111 . cpmn•ss+over WORKERS' COMPENSATION INSURANCE AFFIDAVIT 1, �6+ t-t.o X . grnifee4,..2- (licensee/perminee) - ._ _. • with a principal place of business/residence an • - 2 fA}, /-rt-f, s4e lJlt tttv9n, -�f-. o6 '9Z- (C /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 sole proprietor and have no one working for me. - - - - - - [ ) I am a sole proprietor, general contractor o • (circle one)and have hircd the contractors listed below_ .. . who have the following workers' compensation insuan- policies: •,.:..,••.. .... - • Name of Contractor . Insurance Company/Policy Number . • ... .. . Name of Contractor Insurance Company/Policy Number - Name of Contractor Insurance Company/Policy Numbei - 1 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 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.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 Accidents'Office of Insurantx 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 31500.00 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 against me. /7-Signed this 0/ / civ of •k , 19 , i______ — - i Lice::see!Permir:t Licensor/Permirror • Suggested Affidavit for Home Improvement Contractor Permit Application • For orrice Use Only NAME OF CITY/TOWN Permit No. Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL e.142A requires that the"reconstruction,alteration.renovation.repair.modernization,conversion,inprovement,removal,demolition. orconstruction of an addition toanv precxistinq owneroccumed huddinzcontaininq at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other requirements. Cc,—) Type of Work: Atrzel Est. Cost ,S ftom~ mto Address of Work 5D Z 12, Owner Name: R ,YD iaz" b Date of Permit Application: 7// 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. Id2A. Siened under penalties of perjury: ! hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: • Notwithstanding the above nnoottiicee,,,II hereby apply for a permit as the owner of the above property: tcc Owner Name