HomeMy WebLinkAboutBLD-93-696 di3/44 6l 9/9�93
'.44.- ', iitk o TOWN OF YARMOUTH o pw slily
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0 44‘ '—H'
��,"gi n 15'0 Application for a Permit to Build No. (89(0
UPON FINAL APPROVAL %01` I 0/13 MAP /a& 'OTg (‘9
FEE MUST ACCOMPANY THIS APPLICATION. DATE it10 C 19 9 S
The undersigned hereby applies for a permit to build Tb#,--3
according to the following specifications /' ///#93
1. Name of property owner 7O4t- G19StFTel.SC '/D02
Address 17 El p FP SR' 7/9-Ttw0 A r g-,F 7-
2.Name of Architect(if any) Tel.
a Name of builder. Oki-,a2 Address
4. License No. Tel.
5. Name of Mason Address
6. License No. Tel.
7. Construction address (7 FI;FP Sf YtM-14-ro-o14a2c
Flood G District � �
8. Date of subdivision A I plain;one 16 Zone
9. Private dwelling Estimated Cost Qgc�x '4DO NgT WRITE IN THIS SPACE
10. Multi family 0 �$ _blo�J asrr r4o, Type of room No.
e 6o // 9�q�93
11.2Commercial 0 -Kitchen
12. Other 0 Dining Rm.
m.
13. No. of stories 2st/X Living Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 i 0 Bed Rm.
0 -rt, pip Bath
15. Materials — Wood 0 Cement 0 Other ❑ rfL Deck .2yy?� 7
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
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.O E. No. ��
LOT RELEASED BY Signatur C�/
PLANNING BOARD Ad e r 7 qa I'
Date 0- - `
�-
APPLICANT: JQ�4'v ans E CL BUILDING PERMIT i`:
G
ADIIRESS:' /7 ( DER- S C TELE. NO. : 35. 4. (5 ( R DATE FILED:
f mit
BLDG. SITE LOCATION: /7 From St /42ire.kri APll: �v2J LOT/f: V 4f 9'
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 COP '1ERCIAL 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 TUE REQUIRED BUILDING PERMIT:
REVIEWED BY:
1. WATER DEPARTMENT DATE: N/A:
2. ENGINEERING DEPARTMENT: DATE: N/A:
3. CONSERVATION: 45 err DATE: / — 43 N/A:
4. HEALTH DEPARTMENT DATE: �( — 3 N/A:
IpIUST IAL AND/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR: DATE: N/A:
G. 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:
BLM/89
•
TOWN OF YAMOUTU
BUILDING DEPARTMENT
HOMEOWNER LICENSE mITION
PLEASE PRINT:
DATE Q / I 15'3
JOB LOCATION /9 • f/ DE 2 SJ/3RMov iI ART"
NUMBER STREET ADDRESS ECTION OF,TOWN
"HOMEOWNER" JO Lt h. Gm 4<f, 35s 'f LO Z • flY 2t &s-ro
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADRESS /33 Sc Leif- Si
So• ,{i9rs,tAren/ /17/i D/Sn
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 WHICH HE/SHE RESIDES OR INTENDS TO RE-
SIDE, ON mum 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 THE BUILDING OFFICIAL,
ON A FORM ACCEPTABLE TO TILE BUILDING OFFICIAL, THAT TIE/SHE SHALL BE RESPONSIBLE
FOR ALL SUCH WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1)
TILE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH TUE STATE
BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGULATIONS.
THE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH
BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE
WILL COMPLY WITH SAID PROCEDURES AND REQUIREMENTS.
HOMEOWNER'S SIGNATURE - 1ia�.[(�/�
APPROVAL OF BUILDING OF CIAL
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 COVER :
I have a current Iia ,,r insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have checked yes, please indi to the type coverage by checking the appropriate box.
A liability Insurance policy Other type of indemnity 0 Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Che e:
Owner Agent ❑
. Signa of Omer or er s Agent
•
C, eL4- .
„
COMMONWEALTH OF MASSACHUSETTS
• �^' =�,,—r= DEPARTMFNTOFINDUSTRIAL ACCIDENTS
C>- e! 600 WASHINGTON STREET
•
James J Camvoei. BOSTON, MASSACHUSETTS 02111 •
'ornn:ss+oner - _
WORKERS' COMPENSATION INSURANCE AFFIDAVIT •
I, Ua4t- 6pflI G- LL _ .
(licenser/permittcc)
• with a principal place of business/residence an1/42rz tel•
/7 V 1J era S ( Wl0 Lr'�7 yi�o/L� . '
(City/State/Zip) p
do hereby certify, under the pains and penalties of perjury, that:
[3 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 me.
O I am a sok proprietor. general contractor o homeowner 1 irde 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.
NOT•.Please be aware that while homeowners who erpioy persons to do cainteaaaa, coostrucdoc or repair work op.a
dwelling of not more than three units in which the homeowner also resides or on the trouoCS appurtenant thereto art not centrally
considered to be employers under the Workers' Compensation At:(GL C. 152,sec 1(5)). application by a homeowner for a license
or permit may evidence the lenal tutus of an employer under the Workers' Compensation Act.
I understand that a copy of this statement will be forwarded to ti•.c r-..rc-en:of Industrial Acddene' Gina of ins_aper for coveraze
ven:i::::on and :ha: failure to secure coven:: as moulted under See-don 25A'oI MGI. 15: Gth lead to ..r_ .r :o:i:ion of criminal penal tie
conm:rr..: of: f;.^.e of u: to 5:500.00 :nd:or impruonm_.t of up to one year and C}ii penances in the form: of:.5.::: a ork Order and 2
fine e:5100.00 a day az:in:: me.
Sign:d thisere-. •-(9-2,n.. ue, cav of 3 19 1-3g
.
•Suggested Affidavit for Home Improvement Contractor Permit Application
For office Use Only / NAME OF CITY/TOWN�Y
Permit No. 2/�aoe?4.pees fir
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 pre-existing 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-T, A/ter at. Cost 500.
Address of Work /9 AD.F/z T l 1 1& 7'/MU cif �r
Owner Name: D z(h� ccgsre u
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
_Bui • g not owner-occupied
caner 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 for a permit as the owner of theabove property:
/Sr 6;4 g/I-srELL --4,-C-2-64.4.0
Da Owner Name
- 4
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FGR, LOT
•r:' Indicate locatcn of'Sarage or accessor
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.: : - _ LOT NO. : 49 ADDRESS: 1-7 EIDER ST. .
OWNERS. NAME: JOHN GASKFIT =
SEWAGE PERMIT NO. : . ' NEW: ' REPAIR:
DATE ISSUED:_ 71 DATE INSTALLED: . •
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•. - 2. - - H INSTALLERS NAME: • CASH . :
INSTALLATION OF:
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WATER TABLE: FINAL INSPECTION BY:
• DRAWING OF INSTALLATION ON REVERSE SIDE:
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Old Kings Highway Regional Historic District Committee •
I��I `V'` !' . in the Town of Yarmouth for a
r
CERTIFICATION OF EXEMPTION
Application is hereby made, in triplicate, for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470,
Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans, drawings, or photo-
graphs accompanying this application. •
Q
TYPE OR PRINT LEGIBLY •^� DATE '/ ti �j t- / s C I
ADDRESS OF PROPOSED WORK /1 ii Of a 5 I ASSESSORS MAP NO. 123
OWNER 17) L 4, G r;Frit_ ASSESSORS LOT NO. N n
HOME ADDRESS SSS SCLrOGL cr .�.. #7437tkraI/ Ant TEL. NO. 47 -7 6 Ass3
AGENT OR CONTRACTOR �JE4-it-eif? 59 e
/ =_J W
ADDRESS TEL--z 0.
rr-j g tZ7
This kation is for exemption of proposed exterior construction on the ground that:
�.�
I k' N t
C (1) It will not be visible from any way or public place. 1 — . CC
C (2) It is within a category declared entitled to exemption by Old King's Highway RegimnaTHistgic Dist?•tet Commiss'oh.
(Check applicable box) D`.=
•a ._ S 0
PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot;-and, if aotddition is involved, show-
ing location of existing building.
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Er S III triPPROVED
5/ -C Lf X AY- YARMOUTH COMMITTEE
I OKHRD
•
SIGNED / /
Owner-Contractor-Agent
Space ge'ow line for Committee use. j
Received by H.D.C. The Certificate is hereby
j , r
Date 916ITY /• ' •.•_/ .r/ afi. �!_:. i, �.
5
Time i • -1- 4 ,,. 11 j ,�_
B/ •
GL.� D..I n
The ca:as:ries of vicrk entitled to exemption are i s:a: ^
?pa:ro:ec -sicP .,.,
0:saar:•:en 77 the back of this form.
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• DATE REVISED OCT08ER 19,1992 980. 246
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C :,,,i^ 310 CMR 10.99
Form 2 DEP FIS No.
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4+ (ro be provided by DEP)
-.1, YARMOUTH
- -=1Commonwealth Cay Town
f 'ie
= s= of MassachuseT: gppl,�ant JOHN GASKELL
ve ri —==
• a -Y t.i(i Imo:..
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DMfehmination of Applicability
Massachusetts 1NPtlands Protection Act. G.L. c. 131 , §40
and .the:Towri of Yarmouth Wetland Bylaw
From Town of Yarmouth ''•Conservation Commission Issuing Authority
To John Gaskell : !I _ Same
(Name of person making request) • ." (Name of property owner)
I
Address 133 School Street= ' Address '
South Hamiltons-MA 01982 .
This determination is issued and delivered as follows:
X by hand delivery to person making recuest on Sentember 8, 3 993 (date)
C by certified mail, return receipt requested on (date) .
Pursuant to the authority of G.L. c: 131. §40. the :'own of Yarmouth Conservation Commission
has considered your request for a Determination of t\pplicability and its supporting documentation, and has
made the following determination(check whicheveris applicable):
Location: Street Address 17 Eider Street‘, YarmouthPort, MA 02675
Lot Number. • 49 . "
1. 0 The area described below,which includes all/part of the area described in your request, is an i
Area Subject to Protection Under the Act.Therefore, any removing,filling,dredging or
altering of that area requires the filing of a Notice of Intent.
2. C The work described below,which includes all/part of the work described in your recuest, is within
•
an Area Subject to Protection Under the Act and will remove,fill,dredge or alter that area.There-
fore.said work reouires the filing of a Notice of Intent.
Effective 11/10189
2-1
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3. 0 The work described below, which includes all/part of the work described in your request, is within
the Buffer Zone as defined in the regulations, and will alter an Area Subject to Protection Under
the Act.Therefore, said work requires the filing of a Notice of Intent.
•
. This Determination is negative: •
1. 0 The area described in your request is not an Area Subject to Protection Under the Act. •
2. 0 The work described in your request is within an Area Subject to Protection Under the Act, but will
not remove, fill, dredge, or alter that area.Therefore, said work does not require the filing of a
Notice of Intent.
3. f The work described in your request is within the Buffer Zone, as defined in the regulations, but will
not alter an Area Subject to Protection Under the Act. Therefore, said work does not require the
filing of a Notice of Intent.
4. 0 The area described in your request is Subject to Protection Under the Act, but since the work' •
described therein meets the requirements for the following exempticn,as specified in the Act and
• the regulations. no Notice of Intent is required:
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Issued by TOWN OF YARMOUTH • Conservation Commission
Signature(s) � `s
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This Determination mug e signed by a majority of the Conservation Commission.
On this 72/Ant
.rfday of ___4-7;t:„Ler • 19 1 , before me
• perconally aooeared /i7% &••m-r Lie 'u - ' , tome known to be the
person described in, and who executed, the foregoing instrument, and acknowledged that he:she executed
the\ame as his;her free act and deed.
..
Nary Public My commission expires
This Determination Does not relieve the applicant from complying with all other aoohcable teceral.state or local statutes.ordinances.
by-laws or regulations.This Determination snail be vah:for three years torn the gate of issuance
The applicant,the owner.any person aggrieves by this Determination.any owner of lens abutting the lens upon witen the proposes work
is to be Done,or any ten restoents of the city or town in which such Ian:s located.are nereby notlhe:of tneir no. to recuest the Department
of Environmental Protection to issue a Supersesing Determination of A:puaouny,Drowsing the recuest is man oy cert:hec mail or nans
delivery to the Department,w;tn the appropriate Marg tee and Fee Transma:at Form as prowoec rr.310 CM t:.037t wnnm ten Days tram
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the owe of ntuanpe of this De:e^.ranation.A,.cpy of the request shat:a:the same time be sent oy cernree man or nano delivery to the
Conservation Commission ens the a=,t:an:.
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