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Home My WebLink AboutBLD-93-692 t %47.'‘ TOWN OF YARMOUTH ° ' Few M TTAIC�ECS �J , / �,hpyEAr J ./ Application for a Permit to Build No. b8✓ UPON FINAL APPROVAL$ I' /11-€.3MAP 7-3 LOT 7(3/ FEE MUST ACCOMPANY THIS APPLICATION. DATE 3.-p+ ., 19 9 3 The undersigned hereby applies for a permit to build V6193 according to the following specifications 1. Name of property owner 3A..3 Es TE e(4 'c '/ Tel. Address 191 mmo r . c- 2.Name of Architect(if any) Tel. 3. Name of builder Edwk.tct 1ZOa . ,tic ( ( Address 738 2i,.!^ R4 MAeak,w MA) 4. License No. n176o3 Tel. 1128-SS79 5. Name of Mason /i4- Address 6. License No. Tel. 7. Construction address 44- / 'f/ fl A.Jat , `1.€1 Flood Ds'strict 8. Date of subdivision Approval plain zone Zone ZI 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE 10. Multi family 0 C3-Oa 1.q PikCr Type of room No. 11. Commercial a'XAr1tww (�44i kv' 3 get,on TX7a �'+ry Kitchen 12. Other ❑ C s O Dining Rm. 13. No. of stories Living Rm. 14. Foundation — Full 0 Half 0 Crawl ❑ Slab ❑ at' Bed Rm. Bath 15. Materials — Wood ErCement 0 Other 0 Deck 16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 ❑ 2 ❑ Family Rm. Sun room 18. Swimming pool - Size Garage 19. Storage shed — Size Shed 20. Stove — Wood 0 Coal 0 Alterations pas 3 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 Side line 25. H.I.C.R. No. LOT RELEASED BY Signature Fes--C._206---- o - PLANNINGBOARD Address '73f3 Rtoe ,. t2c Date M ;44W/W.. 4111 _ bd64f4 '"''a'^"'•'^� ,w,,I3UILDINGPERMIT APPLICATION SIGN OFF APPLICXNT: (nu 1. ' BUILDING PERMIT II: A. ADDRESS: f 9/ i/7 p lru,/• .7)62 TELE. NO. : DATE FILED: • BLDG. SITE LOCATION: sYf/J,e MAPII: LOTH: 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: 4. HEALTH DEPARTMENT DATE: N/A: INDUSTRIAL 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. � �/ COMMENTS: �G.D4 i) /Y/gL ,VO AtinS' 6r' &L t /irrt4-rf.D P4c4 mac BLM/89 x�c � �� y y�-r k• COMMONWEALTH OF MASSACHUSETTS --=QE ie • DErARTMENT OF INDUSTRIAL ACCIDENTS • • -Z, ' 600 WASHINGTON STREET ,lames J Camooei; BOSTON, MASSACHUSETTS 02111 . comm ss ones WORKERS COMPENSATION INSURANCE AFFIDAVIT • I, ea..) Ar R. O(-0,t) e— i ) (licensee/permittee) • with a principal place of business/residence an 73 $ R, °c,r (1c� lMA/th 0L13 kei !N/t na4ze (CirylState/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 ] 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: -c- - . . - 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(CL C. 152.sect. 1(5)).application by a horneowoer for a license or permit may evidence the legal status of an employer under the Workers' Compensation Act 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 iccure 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 me. Signed this 13� ' day of S r• o , 19 Lrcc ;Jtc� Lie..^.ioriPermi .ot TOWN OF YARMOUTH • BUILDING DEPARTMENT • ' • CONSTRUCTION SUPERVISOR FORM rk • ' PLEASE PRINT: ' . . • JOB LOCATION: II ) m, o 'peck fle,uy NUMBER _ . STREET ' . VILLAGE OWNER OF PROPERTY: ' 'YM'mc-S . T/ fee ry/r )/ ' • CONSTRUCTION SUPERVISOR: - %cLiA>C1 e,O,C rS,,Lc" // ' 0/ 766S • ei2 a -SSBI 9j NAME LICENSE NO. PHONE NO. ADDRESS:' 3 8 ' '(Z to ✓a. YYl t4. -S ws ran '11S , YN A4• • ' LICENSED DESIGNEE: • (IF OTHER_THAN SUPERVISOR) NAMELICENSE 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 BE 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•SOLITION 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 IMMEDIATELY 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 1ICENSING CCT- STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDIIiG CODE. I UNDERSTI_:: THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. . INSURANCE COVERAGE: •• I have a current liability insurance pclicy or its substantial ei;uivalent which meets the requirements of MGLtfih.152 Yes O _ No If you have checked v`s• please inci=te the type c average by checking the ap7:cpriate box. ' •...r.:-...".•:'-':'••••.- A liability insurance pcficy 0 • Other type of :.idemnity 0 Bond -• • •• • • OWNER'S INSURANCE WAIVER: I am aware that the r:censee dd�s rot havFt the insurance coverage requirec'• C`apter152 of the Mass: General Laws. ane that my signature cn tats permit :opli=:icn waives this requirert ent •• • - • Check one: • Owner0 Agent 0 Stgnawre oe C'*ner cr O#vner s Agent , • SIGNATURE: h,K�/aLDING OFFICIAL APPROVAL: • .r -h•• ... • Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use only `' NAME_ OF CITY/TOWN Permit No. VA,' vfrt U✓Y"-� Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.142A requires that the"reconstruction,alteration.renovation,repair,modernization.conversion,inprovement,removal,demolition, or construction of an addition to any preexisting owner-occupied building_containing 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. Type of Work: �r�. 9c 4 cow, .� Est. Cost' 00 ei Address of Work 9 ( m , O ere c L D2,i ie Owner Name: -$A,nes Ile.4 c Date of Permit Application: 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. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: 9- i3 - 93Fr�t�a✓el R. fp 1 f 10471 7g7 • Date Contractor Name Registration No. OR: • Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: 9- 11-5 3 Date Owner Name