HomeMy WebLinkAboutBLD-93-697 94 kg
$ r ; ,_ o TOWN OF YARMOUTH og`rna etfri 4,
0 �' i y 4
N MATT.... `
eck...,..n••�'e:• Application for a Permit to Build No. &' 97
UPON FINAL APPROVAL q-14 -93 MAP / 72- LOT S'
�
FEE MUST ACCOMPANY THIS APPLICATION: ' " " 'DATE ?AV • 19 �3
.The undersigned hereby applies for a permit to build
according to the following specific�ons 't =/� " (- /= % e d,//t93
U:Name of property owner, t/nc*C VJ//r,tiI Tel. 3 62 -6AY
Address ''38' ,44, .15.,?..... 2/; , : .yi, ,,.,... e Ienv— Ate-
2.Name of Architect(if any) Tel.
L3. Name of builder ✓'?F a-r- 4.4.---e ' ' `Address —r47.1 di • ,
4. License No. Tel.
5. Name of Mason Address
6. License No. Tel. -
- n '
nstruction address ar dL e k. DCl( A tuom . /pr—
Flood District �_!
8. Date of subdivision Approval plain zone Zone T`0
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
10. Multi family 0 Lir /490• ofl Type of room No.
11. Commercial 0 Kitchen
12. Other a Dining Rm.
13. No. of stories Living Rm.
7I• Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 J Bath
15. Materials — Wood% Cement 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 - /2- k / L. ' Shed l2 X 1 Z /
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. H.I.C.R. No.
LOT RELEASED BYignature i C 5 iI 7, 2
PLANNING BOARD Addre
Date • r
� - ✓ '
• r
d'_,>- • 1
�✓` TOWN OF YANOUTII
• - - -- -- - -- _--- BUILDING DEPARTMENT -
=--.f_=--.HOMEOWNER-LICENSE EXEMPTION
PLEASE PRINT: q
DATE (/03
JOB LOCATION 3 /74/1.-4W-7
NUMBER STREET ADDRESS SECTION OF,TOWN
"HOMEOWNER" F&I 47 C { ch-1/4/-n--1 31 - - 675-/ 22P- 2^G /r,
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADRESS � 'AZ- 64.n o n 602/•
•
(lp�.»44r Art91— "74- Z6ZS -
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 WHICH11E/SITE 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 THE BUILDING OFFICIAL,
ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT TIE/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 THE 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 REQUIRE<ME•NTS AND THAT BE/SHE
WILL COMPLY WITH SAID PROCEDURES QUIREF:ENTS.
IlOtMOWNL•R'S SIGNATURE �
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 MGL Ch. 142.
Yes ❑ Noc0
If you have checked ves, 'ease indicate the type coverage by checking the appropriate box.
A liability Insurance policy 0 Other type of indemnity ❑ Bond 0
OWNER'S INSURANCE WAIVER: I ,.,;i aware that the licensee does net have the insurance coverage required by
Chapter 142 cI the ca. General -.ass and that my signature cn this pers♦ appUcticn waives this
requirement.
Check one:
Owner Etre- Agent
. ,.era cr Owner s AC• __ ___ "_
PLOT PLAN .
•
61_ S--
FOR LOT #
Indicate location of garage or accessory building
Additions with dashed lines
Sewerage disposal (cesspool)
Well f
I (lot ft. rear)
Abuttor I s I Abu
Name I Nam
Lot # • I • Lot n
REAR YARD •
If this is a • If t
corner lot, 1 ft. • corn
write in name writ
of street. I - name
• I • a ..oth
Qail sire
C • . . ro
'o •
. d
SIDE YARD . •
SIDE YARD
• HOUSE
FT. 0 . • 0 FTI) .
•
. SET BACK
• • ft. u
a
I
I
V-
•
(lot ft. frontage) ..
•
\ / '
\ /
\ / (NAME OF STREET)
/
/ \ -Information
/ \ Suopliei by
/ \
Suggested Affidavit for Home Improvement Contractor Permit Application
•-
For Office Use Only NAME OF CITY/TOWN
Permit No.
Date
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGLc.142A requires that the"reconstruct ion,aItem tion.renovation.repair.modernization.conversion.inprovement,removal.demolition.
orconstruction of an addition to anvpre-existing owner-occupied building containing at least one but not more than four dwelling units....or -
to structures which arc adjacent to such residence or building"be done by registered contractors,wnh certain exceptions,along with other
requirements.
•
Type of Work: f46.73/-- ' ' -- - - - Est. Cosi /5's
Address of Work if /'7`vc<Cq,, 0,,, /••:=. ...-- .9..4r- ��-
Owner Name: -:a f l/ ,
Date of Permit Application: - 4//1 — - -.
I hereby certify that: -: ---
•
- Registration is not required for the following reason(s): -- - -- •
. -.
_Work excluded by law . - _-- -_-- -
__ •
Job under S1,000'
Ouilding not owner-occupied
wner 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 "
e. 142A
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR:
Notwith tand'ng the above not' , reby app y for a permit as the owner of the above property:
Dat Owner ame
' "•=' COMMONWEALTH OF MASSACHUSETTS -
__
DEPARTMENT OF INDUSTRIAL ACCIDENTS
' 600 WASHINGTON STREET
James Gamooei, BOSTON, MASSACHUSETTS 02111 -
Commissioner .4. .
WORKERS' COMPENSATION INSURANCE AFFIDAVIT
I, Ain c�Cc/v l/ic--
(licensee/perminee)
•
with a principal place of business/residence an •
3c? /��4,-2...n '
(City/SnteiZip) '
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 sok 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 -
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 art 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 lnsurantx for coverage
verification and that failure to&cure 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 aim:me.
Signed thi -. l Q
r fit day of crE/" ie--..6e'ati19 �-�
.. �G j�-
Licensee/ ,.. LiccrsoriPcrmiror
- , Application to 3 7 2.6- A
+ c 0
t ++'`r;�'y;;+ Old King's Highway Regional Historic District Committee
r r�•,( r-..\ - in the Town of Yarmouth for a
!y • " CERTIFICATE OF APPROPRIATENESS
Application is hereby made in triplicate,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470e
Acts and Resolves of Massachusetts.1973,for proposed work as described below and on plans,drawings or photographs
accompanying this application for. :_._ 7 . _ .
l CHECK CATEGORIES THAT APPLY: -Cr xo w' xt
1.Exterior Building Construction: ®New Building O Addition ❑Alteration / � .. --• r'�Z - - m
•
Indicate type of building:0 House 0 Garage 0 Commercial teOther f t l'" r t;!
2.Exterior Painting: 0 ;.. Gs.375. ea O rn
3.Signs or Billboards:0 New sign ❑Existing sign ❑Repainting existing sign �X <-
4.Structure: 0 Fence 0 Wall 0 Flagpole ❑Other _n` O TT.,
read other side for explanation and requirements). .. . c--+ C:,
TYPE OR PRINT LEGIBLY J - DAT / 93
ADDRESS OF PROPOSED WORK /3 j�c /��o.., ��. �^Q0 L r ASSESSORS MAP NO. �0�2"
OWNER � r�"�• //� r"� ASSESSORS LOT NO. 65-
HOME
mssHOME ADDRESS " J'Airne - SesTc TEL.NO. 362" - "r7
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property��owners across any public
street or way. (Attach additional sheet if necessary). RtcX 4/[A 4/e /(A-E #"_S 2- /-44-44-tee's to/
' QA, 74,— 1t . Xe/,r/f /�/may - �.-a.r.r P/n e t .
0 /y t)h/✓ 1-A L/i . kitse+2N 6-;,0 0/4„>„; �q 4CraJT' .f�i-1s
W i//'Art theme- /2z Ac.,,,,-/- ✓ ants ,jq- d��y,;,,,, //And
02-0 2-I
AGENT OR CONTRACTOR Pair,:k Jili'/r9'"i TEL.NO. ...Xt.—66-7
ADDRESS f4 e" 41 44.'E
DETAILED DESCRIPTION OF PROPOSED WORK:Give all particulars of work to be done(see No.8,other side),including
materials to be used. if specifications do not accompany plans. In the case of signs, give locations of existing signs and
proposed locations of new signs. (Attach additional sheet,if necessary).
•
7L,
. . .. n _ .
Signed
er-Contractor-Agent
pace below line for Committee use. ^" •
Received by H.D.C. - '. . .r
_
Date /� 413,The Certificate is hereby/��-" " ^''"'! " • -•%�` Date `7//`, '"; / - '-'
/� !rte / Irl..: J
Time 1-'i♦-h? � /f fj/ /:`!• ,1 y / ' W /// ,moi �.
By ani . ..r, r; ,
.`ped Qr IMPORTANT: ` If Certificate is approved,approval is subject to the 10 day a�p e��led,ED�,,F�
✓� proviced in the Act. - - lAR)f,OUTH CO)AtAITTEv E~
2.sacr.rovea 0 Please return to: Yarmouth Historic District Committee•
- -
. Town Hall. 1148 Ht.28. Scuth Yarmouth. Mass.02664 IIKHRD - - . -
ass.. 'NS
•
ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATION •
FOR A CERTIFICATE OF APPROPRIATENESS - •
The tour categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a
separate form).
1.EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a
building tot;erected.or altered including windows,doors,siding,roof,light etc.,that will be visible from any public street,
way or public place:T_he following scale drawings are required in duplicate with application:two plot plans(if addition-show
existing buildings in outline),four sets of elevations.Also required are snap shots of existing buildings,where additions or
alterations are to be made.No plot plan is required for addition or alteration which does not touch the ground.
C.,./ -v
2.EXTERIOR,fAINTING:An application is required for any portion of a building,structure or sign to be painted that is visible
from alpublia street,way or public place.Color samples must be attached to these applications.An application is not required
when iepaintirig existing colors,changing to white,or using colors approved by the Town Historic District Committee.
3.SIGNS OR BILLBOARDS:An application is required for any sign or billboard to be erected within the District,with the
following exceptions:
a. Existing signs or billboards on November 27, 1974 shall have until November 27, 1977 to secure an approved
Certificate of Appropriateness.
b. Temporary signs for use in connection with any official celebration or parade or any charitable drive as long as they
are removed within three days of the event.Certain temporary signs that the Committee feels does not detract from
the Act may be allowed with the prior permission of the Committee.
c. Real Estate signs of not more than 3 square feet in area advertising the sale or rental of the premises on which they
are erected or displayed.
d. A single sign,of not more than I square foci in area showing the name,occupation or address of the occupant of the
premises on,which they are erected or displayed in a residential zone. c
� '":� • .,,aha
4.STRUCTURE:An application is required to build or alter any structure within the District which is defined by the Act as a
• combination of materials other than a-building,sign or billboard,'but including stone walla,flagpoles,hedges,gates,fences,
etc.. . . -
•-
GENERAL REQUIREMENTS
S.Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the
Town Clerk by the Committee.Approval is subject to the 10 day appeal period provided in the Act.
6.No changes shall be made from the original approved specifications without advance approval of the Commission on an
amended application filed with the Committee.
7.A separate application must be filed with each project requiring a Certificate of Appropriateness.
S. Under heading of "Detailed Description of Proposed Work" give detailed data on such architectural features as:
foundation,chimney,siding,roofing,roof pitch,sash and doors,window and doorframes,trim,gutters-leaders,roofing and
pant color.
9.Unless application is complete and legible and all material required is supplied,application will not be accepted or acted
upon. -
Copies of the Act establishing the Regional Historic District may be obtained at the Town Hall. __ _ ___-- --
Yarmouth Old King' s Highway Committee
SPECIFICATION SHEET
' le (Submit 3 copies) 3 7 2.. 4
ck s//i�
- APPLICANT (OWNER) .. A
FOUNDATION (18" max. exp.) : CONCRETE/OTHER
it-r r& 6/oc t
SIDING TYPE: COLOR:
/4„,4 lilt -• J4i
t Ce14r •�c� f e /vJr
CHIMNEY (indicate brick/stucco/woodfaced)
ROOF MATERIAL: PITCH: COLOR:
,4s-t04 1J (I- ikei (7/12 minimum) 144 noTec4 /ro,.,rc
WINDOWS (grilles required) --Indicate sizes if not listed on elevations:
/
DOORS: (% ) SIZE: .36"x �D" COLOR: .(,
Sti,i lgn hog
TRIM: - (all windows & doors trimmed 1x4/1x5) COLOR:
/)0 S .. 4//.71€
SHUTTERS (wood/vinyl) : COLOR: .
GUTTERS (wood/aluminum) : • - ; C(rI�,OR: n
GARAGE DOORS: SIZE: COLOR: o -
._m3 `c . in
v r-T
STORM WINDOWS & DOORS: SIZE: .C45R:
. . SKYLIGHTS (FLAT ONLY) TYPE/SIZE: • - COLOR:
DECK: SIZE: • COLOR:
FENCING (max. ht. 6 ' ) : STYLE: COLOR:
(show layout & running footage on site plan)
91I1 APPROVED Da
ADDITIONAL INFORMATION: ARf'nim, ;P C
, WIRD
NOTES: Color chips required. Outdoor lighting, electric meter and .
landscaping- -show on site plan for new houses only. _- -_ -.....
rev: 6/93
4 •
Yarmouth Old King's Highway Committee
SPECIFICATION SHEET
(Submit 3 copies) 3 72.
APPLICANT (OWNER) : - elLni*
FOUNDATION (18" max. exp.) : CONCRETE/OTHER
1jloC
SIDING TYPE: / / l COLOR:
11/11Yr Ctd 4✓ jI n f/cr /1r~/
CHIMNEY (indicate brick/stucco/woodfaced)
ROOF MATERIAL: PITCH: / / COLOR:
QA�hL. (7)/4h (7/12 minimum) Vick ,1,4k%
. WINDOWS (grilles required) --Indicate sizes if not listed on elevations:
DOORS: C4 ) / SIZE: 3411 )r 8011 COLOR/:,
4-44 Oor h Giro/
TRIM: - (all windows & doors trimmed 1x4/1x5) COLOR:
/SGS 4/Cie
SHUTTERS (wood/vinyl) : COLOR:
GUTTERS - (wood/aluminum) : CW,OR: w :Z!
• Tx
m
0
GARAGE DOORS: SIZE: CQ5.OR: rn
G
A m
STORM WINDOWS & DOORS: SIZE: Ccd'B: 'o
cs *a„
SKYLIGHTS (FLAT ONLY) TYPE/SIZE: COLOR: ,.
DECK: SIZE: COLOR:
FENCING (max. ht. 6 ' ) : STYLE: COLOR:
(show layout & running footage on site plan) TAWApPRONEDGOL'—
YARMOUTH COMMITTEE
ADDITIONAL INFORMATION: OKHRD
•
•
NOTES: Color chips required. Outdoor lighting, electric meter and
landscaping--show on site plan for new houses
rev. 6/93 6/93
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SETBACK REQUIREMENTS OF THE TOWN OF /a.3'4awVC /BCH
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