HomeMy WebLinkAboutBLD-93-691 -•,py. '
ig- r o TOWN OF YARMOUTH -i �'�°/%93
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CS,,< „t,. 0;" Application foroa Permit to Build No. 6q/
�d _/ -is-9MAP 02-2 LOT ��
UPON FINAL APPROVAL , /
FEE MUST ACCOMPANY THIS APPLICATION. DATE
The undersigned hereby applies for a permit to build 9b3 93
acco ding to the following specifications ',44.93
Name of property owner 430v.d f'fte-- Tel. 79'0483G
Address Ito C.levrlo.rcl. Wo ivy
2.Name of Architect(if any) Tel.
a Name of builder Address
4. License No. Tel.
5. Name of Mason Address
6. ense No. I v Tel.
. Construction address 1 i4 die ve/n-of w w.y
Wel
District ,-jzf-
8. Date of subdivision Approval W plain zone C- Zone
9. Private dwelling 0 Estimated Cost g.,�i bDO jVOT WRITE IN THIS SPACE
w/a.�deo. Type of room No.
10. Multi family 0 f �� DES /
11. Commercial 0 Kitchen
12. Other ❑ S7`o Dining Rm.
13. No. of stories •_J o. CP) Living Rm.
Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 LY /7 1 4'a $g L Bath
15. Materials — Wood 0 Cement 0 Other ❑. 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 _Tier C6' Shed Sx J6,.
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
23. Distance from nearest building: Front Ft. side Ft. side Rear
24. Distance back from line or street From rear lot line /0 ` Side line z°'
25. No. /� -4 --` _
LOT RELEASED BY Signatures Y.� )`
PLANNING BOARD Address /4 Fleur/a,..d al,
Date Pit/ •
•
TOWN OF YAMOUTH
BUILDING DEPARTMENT
•
HOMEOWNER LICENSE aITION
PLEASE PRINT:
DATE 7 -23'- Ci3
JOB LOCATION // CJr✓e%n d & We-3V' qi.
NUMBER STREET ADDRESS Cr SECTION'OF;TOWN
"HOMEOWNER" ,Dn rid 42t Cra 790 #136
NAME HOME PHONE WORK PHONE .
PRESENT MAILING ADRESS /Z Wen+u o rMr D r
/re 6r.. . 4494. oisd/
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) 14110 OWNS A PARCEL OF LAND ON WHICH HE/SHE 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 TUE BUILDING OFFICIAL,
ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, TUAT HE/SUE SHALL BE RESPONSIBLE
FOR ALL SUCH WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1)
THE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH THE STATE
BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGULATIONS.
THE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT BE/SHE UNDERSTANDS THE TOWN OF YARMOUTH
BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE '
WILL COMPLY WITH SAID PROCEDURES AND REQUI' aI TS.
HOMEOWNER'S SIGNATURE 4347k,-7,*
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 of MGL Ch. 142.
Yes ❑ No
If you have checked ves, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy 0 Other type of indemnity 0 Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does net have the insurance coverage required by
C apter 142 of ttre Mass. Geral Laws, and that my signature on this permit applicaticn waives this requirement.
•
Check one:
i
Owner 14 Agent ❑
Signatc:e ct •nr.er or •finer s Agent __ . --
PLOT PLAN
FOR LOT # rn .a . '36
Indicate location of garage or accessory building
Additions with dashed lines
Sewerage disposal (cesspool) ® .
. Well D
• I
• (lot 175-' 98. ftrear)
let -Q.
Abuttor's I ! . _ _ I Abutt
Name _- - IS__ j stfd , I Name
Lot # K'4-1 I • Lot #
. 37
REAR YARD
If this is a • ,...,5- • If tl
corner lot, 1 ft. come
write in name writ
of street. : _ I name
' I a ..othe
0 stree
ro
•
4 . . .
SIDE YARD . SIDE YARD
HOUSE L 1/5 .
�1 �/ +�
c, S 7 FT. t'� . • `] FT�y
N.
•
d Q '
• •
SET BACK
J
S
I
I
(lot i F° ft. frontage)
i/4/ c/«6:c, litt
/
/ (NAME OF STREET) •
• \ / '
/ J `\ Information
re( K1. //-?-7 9
/ \ \ Supplied by e / l
Suggested Affidavit for Home Improvement Contractor Permit Application
For Orme Use Only NAME OF CITY/TOWN
Permit No.
Dote
Al-r1DAVIT
Home Improvement Contractor Law
•
Supplement to Permit Application
MGLc.142A requires that the"reconstruction,alteration.renovation,repair,modernization,conversion,inprovement,removal,demolition.
or construction of an addition to any pre-existing owner-occupied hudding containing at least one hut 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.
Type of Work: SI, ye) Est. Cost 600. oa
Address of Work 1 t It. C( 10,t-e( 4 (o
Owner Name: Wim., rn'- 0 rq"t—
Date of Permit Application: B'—
I hereby certify that:
Registration is not required for the following reason(s): -
_Work excluded by law
4Job under S1,000
_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 apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR: •
Notwithstanding the above notice, I hereby apply fo a permit as the owner of the above property:
Date Owner Name
•
' t •COMMONWEALTH OF MASSACHUSETTS
• DEPARTMENT OF INDUSTRIAL ACCIDENTS _
,id' 600 WASHINGTON STREET • •
James Campoeu BOSTON, MASSACHUSETTS 02111
Commissioner WORKERS' COMPENSATION INSURANCE AFFIDAVIT •
I, myth /Z°- 61/"S.
(licensee/permiace) •
• with a principal place of business/residence an
(City/Sure/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 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
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 Insurance for coverage
verification and that failure to s'ecure coverage as required under Section 25A'of MGL 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 5100.00 a day against yme.
Signed this b) --al //G `✓f day of /947.4 Sh 2 3 , 19 aT
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Licer see Permi :et' LicensoriPermiror