Loading...
HomeMy WebLinkAboutBLD-93-700 *4;,t4lr o TOWN OF YARMOUTH a Fel) - 0 y . N ""r�n.:n. 5 fl Application for a Permit to Build No. '100 fd9,15- 93 UPON FINAL APPROVAL MAP dc217 LOT cS—/ FEE MUST ACCOMPANY THIS APPLICATION. DATE _ 1/4-9 13 The undersigned hereby applies for a permit to build W/579-3 according to the following specifications y/ /s'93 1. Name of property owner 0sd4,2 tridiZo/t if TA°G, Tel-rote 55 *€ C. Address -5-3 7 Vied.ref P.-7 7,9.dw„p 2.Name of Architect(if any) Tel. 3. Name of builder/fifty i..5 D� dwAl. Address tr//Anvri o`, Nes 4. License No. 4/9 S? 9 Tel. 174 3 e ^-2-0 3 ? 5. Name of Mason Address 6. License No. Tel. 7. Construction address 015— O - � criii v- p-0-J7 Flood District 8. Date of subdivision Approval plain zone C.- Zone L.3, 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE Type of room No. 10. Multi family0 �0^ / '-°-° ra -_4 RKS. @3•5-. 11. Commercial an nolo EPP Roans- r`o2 Kitchen 60 12. Other ❑ ° FFICE s P"cc, ea/Dr- Dining Rm. Living Rm. 13. No. of stories . . Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath 15. Materials — Wood 0 Cement 0 Other 0 Deck 16. Type of heat — Oil 0 Gas 0 Electric 0 Other ❑ Closed porch 17. Garage — 1 ❑ 2 ❑ Family Rm. Sun room la Swimming pool - Size Garage 19. Storage shed — Size Shed 20. Stove — Wood 0 Coal ❑ Alterations G 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 Signatur/ —,_ — PLANNING BOARD Address -s- /..i _ Date / i49/93 Fes' BUILDING PERMIT APPLICATION SIGN OFF AAPPLIZANT: DS'G.r irgyion '$. .LN &° r BUILDING PERMIT it: - - ADDRESS: ) 3 ` C//4 (rc-r ,10,61.-it TELE. NO. : 3yy--(i 5/� 1 DATE FILED: 3/'_ BLDG. SITE LOCATION: - a-� MAW I: P7 LOVE: J 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 1 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: 'j-/-cn N/A: 4 NDUS IAL AND/OR COMMERCIAL PERMITS ' 1 5. WIRING INSPECTOR: _727�vy," DATE: ATM 1.' 1993 N/A: 6. PLUMBING INSPECTOR: t f...,I//jj �of , I f q I\- DATE: / -, -A, 9 N/A: 7. FIRE DEPARTMENT: /t7'�cho ✓ DATE: If /-. 9;' 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:60 NU .ayVt. c> rAtetiC /Y/eitn-o /i///7l n/�ac- c' Tileor /dam+- e v7S i� e zn.n7G.Accc A/07C 77r to,r% -nin'2 ,dY7 (.1',tier, ��yJ �l / B I-01G � i4--',117-/z-A'77FA/ No 7 5 4n-o N/ Ini w. as c rm O -Ffov, c?4cE 4- //rIM3,rC�Fm K,Nptrtt.NGt fort- g 0C4fr /<fls>o,Y-L eon,/-tt r 1.1 vty . g prc S` �s Q ft.G 73 finite, LnyyylterLs 49 OZ-42 773 SV-,/ l R-#PPGan° /gm?) sv r�ec,r "ten' (9I'oniltcr FT) NIL IF,Fcaa.09-7-7OW Cif- Sf''s,/N/ct.ex / t-as i'r / BLM/89 tom/ ' TOWN OF .YARMOUTH . - ' 1 • 4.,� • BUILDING DEPARTMENT - _ CONSTRUCTION SUPERVISOR FORM + .' PLEASE PRINT: : JOB LOCATION: .. •Q ` —2— Cz/ : Vats: /.°41.,t---1 . . • •. NUMBER • SEET VILAGE './ OWNER OF PROPERTY: OSa ' .0/./•-i2 '5 4q_TM e••• ' • . CONSTRUCTION SUPERVISOR: /re v,K/ O/' o/ !II'.4 0/7—�/; • '(•"3n _it 3 • NAME . . LENSE N . • . PHONE N0. . . y ADDRESS: (5--- Nape 12,4;--4 .� /1/ •�S • Aig le Sol, c•-; •�(it A•, © AMS- •: " • LICENSED DESIGNEE: ' ' (IF OTHER THAN SUPERVISOR) NAME - LICENSE 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 /J AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE r CO:L•MONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB- • f 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. • i 2.15.4 ANY LICENSEE WHO SHALL WILLFULLY VIOLATE SUBSECTIONS 2.15.1, 2.15.2 OR 2.15.3 OR ANY 1 OTHER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS &MENDED, SHALL 3E SUBJECT ;' TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. : ''• ' ••- , , I 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 DEMOLITION 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 I.`_MEDIATELY 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 .ICENSING CC STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTF_ ' THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDIN.. OFFICIAL. . . . . - •, . . . • INSURANCE COVERAGE:nt li tl6 • ` •• Jp I have a curreit•/ insurance pclicy or its substantial equivalent which meets the m requireents of MGLtth.152 Yes J-. .. No ❑ It you have checked v`s. please indicate the type c average by checking the apr:cpriate box. ' • A liability insurance pc:ic/ O;ler •typeaf :ademndy 0 Send 0 -" - . OWNER'S INSURANCE WAIVER' am aware that the ccensee deer net kw.. :he insurance coverage require: _y C of the !Haas. Goner t_ws• and that my signature en tns pe•.rmt ::721::::::n waives this requirement" f / - Check one: Cht - .„— Agent G <_-natu:act. ..ner cr 0,ner.Agent A .4.SIGNATURE: BUILDING OFFICIAL APPROVAL: - - . - — • . :,........./–.7--,n----rce,.. i ,wc,---3-,.-v Si 7%2.5 0_1, s-c,rii 1, id 4, SI/Y..ell It...1-7., ;loci .. :4:4 • .,•ei V X 11 47, e „42.c4-1-77 -7.77f;"cr-TO d' . ' -— •- :4;--el•0 447-1".7--- Err cr wek-,s-.7: 4/ I I be r -- a, t •d/1 • I I ! ______ ____r_. AF/07- ! I I . I . • LC) 1.fret I .. . r „r5i111 ti I 0 . ! . .. ! i : . . ,.. _. ic...........;:! —10 : t 7 . --------'N I \ gc 1 CY I '• 0 . . 11 'A . 1\.1. 1, ' 4.• r• • . . ..41,".' fl t------- --.7 ,... „ it . 4 IT : f \\ .•, .. __, • i , • ., , • I r ; ..-C• • . ... I f p ” I z.4.- ..." •, 1 i , L-) 1.7. :nor 1 • . , ._.. _t_ _ t: . - 1 • ' 0,, 1"‘ I -_;,-- .i.-- --. H . 1 A I L---,...-, - I:. t_. - . i - ..I.- 105- I ' , • > ;.:.-, 40. ti OW I •=0.___c_____t .el Cs i‘1/4 J ! ry —544- - t ' --44.4— 1 ,9 I or, ,, 0/ .PI,-. ..f 6"----714, . I ' . . • I __= - COMMONWEALTH OF MASSACHUSETTS •' `mak DEPARTMENT OF INDUSTRIAL ACCIDENT'S 600 WASHINGTON STREET -tamesJ Canvoeu BOSTON, MASSACHUSETTS 02111 Con,m ss onet WORKERS' COMPENSATION INSURANCE AFFIDAVIT • I, /e C'� (licensee permittee) • with a principal place of business/ esidence 3 mio� — /cPer (CiryIStateIZipY do hereby certify, under the pains and penalties of perjury, that: [13‘m am an employer providing the following workers'compensation coverage for my employees working on this job. Insurance Company Policy Number [ j 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 • 0 I 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 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 sums 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 lnsurantz 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 $1500.00 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 pins Signed thi - ,day of 19 License:iPermt-e: LicensoriPermi—,or :,.. :..: • 1len �M -\Yb16 r7 i :v tib _ 1 - . <n WS) '9);.-i,-:•0 :< 9JJ1. ls. r• ^Zr�'YG4 • % o ....in a A:34 1r P11 li vin •.. A 1 V‘111 )t W.v3 W 1.�a 1�^'S 1 2. ..:N -5-cud V Sv r++ ui •,a•O zp. U9 W ! V •%, In • , r JCI 11 Y1' .1M J.rZ'U))G.• • v N U t•t:i ;; iç ')a a \:tpL . I l% i rn • Of «. 'y:}?NI•v/f lF ' tl ¢.ji•s :}K` :r o au CO • 4 ;4ril}4 Jly.. ��I / ° •1 1 II 'i ' ! • . '.'i n�`..:4.. •k .-. ..• r'i. T 1-pm 4 s• ii i . . ' - h)-1 7s' 7 L . c 7 c • �o�ui • i i ls1.1:1 ,•I to - ;i 141r go G4 i 1 i- r in .,9.Z/ 1 N 1 r ;