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HomeMy WebLinkAboutBLD-93-699 ` -'{i4 - '�o. TOWN OF YARMOUTH °Kan.' Viiia 0 -„� 4C�E3'Thwq ‘14Valt"ro..ma fi,' Application for a Permit to Build No. 6 IT UPON FINAL APPROVAL Cry/ • '15 MAP 9V LOT C / z 7 /9- FEE MUST ACCOMPANY THIS APPLICATION. DATE 7 /S. 19 q 3 The undersigned hereby applies for a permit to build c/ /s/cf 3 according to the following specifications �/ 1. Name of property owner ION 762 �J• 00A7/;1 Tel.36# -bt4'€' Address 7 00oAr62rS3/0A) Mt D2 yn2 . Parr 2.Name of Architect(if any) Tel. ,, / L a Name of builder (i/-/4flJ.- e—ZC”S Mr7- Address 33 nR a19© LU •Ebb 4. License No. fl 1423 `/ 1 Tel. 77S - / 72 < 5. Name of Mason _IVA?A? Address 6. License No. Tel. 7. Construction address 7 ( )x.)02PSSio,JA-L D2 110/L. e027 Flood District 8. Date of subdivision Approval plain zone G Zone r. ' 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE of room 10. Multi family 0 q0O e a 5/l)/ Al PCs Tsype A rl nes No. 11. Commercial 0 SfCy�iTds Kitchen 12. Other I//5 pia ��� Dining Rm. 13. No. of stories Living Rm. Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath 15. Materials — Wood 0 Cement 0 Other 0 r Deck 16. Type of heat — Oil 0 Gas 0 Electric 0 Other ❑ 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 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 LOT RELEASED BY Signaturenj PLANNING BOARD Address .55 ichigi3p(L Rd Date LU Ciparn rov-pi MA-. • TOWN OF YARMOUTH • • BUILDING DEPARTMENT . ' CONSTRUCTION SUPERVISOR FORM • PLEASE PRINT: ' ' . „ n• •.� • JOB LOCATION: 7 • OO ` JZFS_1bA112-C ' f2 IL 11, 2T NUMBER _g('• • R S'ZREET VILLAGE ' OWNER OF PROPERTY: ' •W E-L-7( /2 , 1 • u� l) Aii • o� �J r CONSTRUCTION SUPERVISOR: . C PIA?, / I'� i/ /17014 is L' Oce` i / / 7J 917Q.5.---- • • 2 2 ` ) NA{ME� 1 `. . LICENSE NO. , PHONE NO. • , . ADDRESS: 3 v' 1V /941.662 k ALJ i• 1-,h 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 AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE - • COMONWEALTH, 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 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 L'2-IEDIATELY 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:I- STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTA_„ THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. . INSURANCE COVERAGE: ,. - • • - •7:I:'. • . I have a current liability insurance policy or its substantial equivalent which meets the requrements of MGLth.152 •. • Yeses:: _ No ❑ . If you have checked v_s• please indicate the type c:verage by checking the appropriate box- "' A liability insurance policy 0 • Other type of:.idemntty 0 t3ond ❑ OWNER'S INSURANCE WAIVER:lam aware that the Licensee does rrot have the insurance coverage requires tv Chapter152 of the Mass. General L-ws• ane t`a: my signature on is permit atalication waives this requirement. • . ... Check one: Owner] Agent 0 Signature m Oen&Cr Orner s Agent • SIGNATURE: . If 1,.„ 1,,,,j it ILDING OFFICIAL APPROVAL: tiXL • . - ) 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 MGLe.142Arequires that the"reconstruction,alteration.renovation.repair,mexlerniration.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: o< •�K //Tiffs Est. Cost yea. w- - dress of Work e,/ &,U(2//t4S/O 4J f)--C_ cJ/ 12_ 'f f92. POO-, /O , -----Owner Name: • 9 LerEg., e� 6304),69- ----Date of Permit Application: r b. / , / C{' q a- - .. • I hereby certify that: •_ Registration is not required for the following reason(s): Work excluded by law ZJob 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. 112A. Siened under penalties of perjury: I hereby apply for a permit as e age t of the owner: Ci 4r—O/1 h f P.t7 i ZM` \ /0 94 7 Dat Contractor Name Registration No. • OR: • Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name • ` '=- — COMMONWEALTH OF MASSACHUSETTS ,per c � - °e.@ • DEPARTMENT OF LNDUSTRIALACCIDENTS• • 600 WASHINGTON STREET James.1 Carnvoei; BOSTON, MASSACHUSETTS 02111 • Commissioner WORKERS' COMPENSATION INSURANCEAFFIDAVIT • 1, co f,ZGg_rc /) (licensee/permiaee) • • with a principal place of business/residence an 33 Wi9/2-eoR 2d 12). t-t f�2rr►/�t) rt • ( ry/Bute/Zip) do hereby terrify, under the pains and penalties of perjury,that: - - - [] 1 am an employer providing the following workers' compensation coverage for my employees working on this job. • Insurance Company Policy Number [X 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: r- -- • -•• _ •- - • 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:.Please be await 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 Aeddenu'Office of Insurance for coverage verification and that failure to secure coverage as repaired 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 mc. Signed this 17r day of S66t-r , 19 q3 Lice^see%Perrm;:e_ Licensor/Permiaor -,:t.:70.5:1% i, application to 1. , .+' t ,`@ a;. Old King's Highway Regional Historic District Committee ti ' In the Town of Yarmouth for e icai CERTIFICATE OF APPROPRItTENESS r-' w Application is hereby made in triplicate,for the issuance of a Certificate olAppropriateness u&ter Section 6 ftChapter*70, Acts and Resolves of Massachusetts.1973.for proposed work as described below and on FAL t photographs I' ii accompanying this application for: 7.> j p`. • j CHECK CATEGORIES THAT APPLY: :' -0 ! • < 1.Exterior Building Construction: O New Building O Addition ' yAlteration n4 t ,. Indicate type of building:$House O Garage 0 Commercial O Other Z^ 2.Exterior Painting: 0 r 3.Signs or Billboards:O New sign 0 Existing sign O Repainting existing sign . 4..: 4.Structure: O Fence 0 Wall O Flagpole O Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY • DATE n JULY /493 ADDRESS OF PROPOSED WORK 7 Cak'cC en'1ovAL Pt2. ASSESSORS MAP NO. 9/ 1 OWNER w,4L7-e2 J. €' a QEAloit, .,E 6. 30Af,4 ASSESSORS LOT NO. C I L34 � HOME ADDRESS 7 eov/RcriaA/e4L DIP, j'Ai2MOJTi{ PO4( TEL No.%x- —644w ' FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public i street or way.(Attach additional sheet If necessary). F/2/tee, relict L ccn/6,Qeen9A441- l's'. VA-2r-ICL -n yoILT (c l/ SJ JklCrF, DOQenf-E,4 H. In n H ID PINE- RD yj/Di'aa¢nrf Pon' C c/24-,44 ) TILLAMA/; Cbn4 V 144 .40SJ.rr4 NkTra+r#s D,e Vb2tictw{ Parr Cc WI) $f!O/Afer, went-Ye Levan 19 /HAnirocc ftta p 4flantifl , A+A 01043 (clink / WAXY EDWA-2D A /2 Cert-&-ZeznriemCAC be- Wh1� et-wwv1Tf ,r (CII‘ ) • AGENT OR CONTRACTOR • C 44 A ' L e-r til I Tcµ-I ELL- TEL.NO. 7 73^- /724- _ 72S ADDRESS 33 fM - iia- RD W. Y4-21tIdv'1?f M, , DETAILED DESCRIPTION OF PROPOSED WORK:Give all particulars of work lobe done(see No.8.other aide),including ' materials to be used. If specifications do not accompany plane. In the case of signs,give locations of existing signs and proposed locations of new signs. (Attach additional sheet.II necessary).f^r_r CL Z t.etvc vt vfl . 4.7/,vi JKYLlcµrf TYPE VS 7S-Jog 33'Wv csCL In ActotPA••rce wzy44v}77llc/1•E'D Dw4 Le 1C,2 plot eSQNe,e of RI€#y/fA.vD -1-K YL/4 f r" is / f#VCH-Er P. o.v hide -iWveler Pogo ref* ve$LLEv, 4.r -rr/awn/ Signed vit. .` Owner-C tractor-Agent SCice oeiow fins lot Comm,aee use. .. • • " • Received it", by H.O.C. Date 7/"= ",11'. The Certificate is hereby yf Si Date I I 1,....; , Time r • ,..do) .,,r-J ree ''r 'i � ;A - v i `"' s IIII PPROVED ea 4-='=se c IMPORTANT: If Certificate is approved, approval is subject to the 10 day ap fi1& COMMI E provtced in the Act. OKHRD !a:Cresec O Please return to: Yarmouth Histone District Commit:ea ' Tc•..n Hall. 1146 H!.28, South Yarmouth.Mass.02664 W • OWN CLERK & TREASUI H tn. _ Qi ` . Q ti,I . Y 0 . : . . •. . \ . • . W . ILI -II • ilf••!:•--3.-,-;, : • • IN\ j i • \ VC... 1.1!•.-4:4/4,•:.:4". - ' • I[ i -. µµ .r . .__ ____ __ . . . , . , . , • . : .. • . . . . . . , • • --f-:-.-TT-. 1 r=a c a it . I I .: 9 cam, _;a:Y.,:..oc _ _ _ 1- 1 . _ _ ±._ - ,- -H rT - , •- =1) _ • � r , • v • • . ; c . \... ' J • li II R'FF, I N �, .$+ca �Fl ' ; ii -i.^ : . • 1 - . y I • :!17. . ..i I Yarmouth Old King's Highway Committee • '' SPECIFICATION SHEET 3 OQ (Submit 3 copies) ` ` -' APPLICANT (OWNER) : 1i'/4t1 ty) 4 at-PA/Jill/NE O, /3' On//A FOUNDATION (18" max. exp. ) : CONCRETE/OTHER SIDING TYPE: COLOR: c CHIMNEY (indicate brick/stucco/woodfaced) Zi f•z Ili -71n ge L ROOF MATERIAL: PITCH: (7/12 minimum) r(. / WINDOWS (grilles required) --Indicate sizes if not listed on elCYations: zr, w DOORS: SIZE: COLOR: TRIM: (all windows & doors trimmed 1x4/1x5) COLOR: SHUTTERS (wood/vinyl) : II COLOR: GUTTERS (wood/aluminum) : $I()CT,?PROVED CAC--- COLOR: YARMOUTH COMMITTEE CKHRO GARAGE DOORS: SIZE: COLOR: STORM WINDOWS & DOORS: SIZE: COLOR: SKYLIGHTS (FLAT ONLY) TYPE/SIZE: VS Mt-30F COLOR: RACK 2W.o..(04 30"w K SS"L DECK: SIZE: COLOR: FENCING (max. ht. 6 ' ) : STYLE: COLOR: (show layout & running footage on site plan) ADDITIONAL INFORMATION: NOTES: Color chips required. Outdoor lighting, electric meter and landscaping--show on site plan for new houses only. rev. 6/93 . , e ' / r c4\4z/APPROVED Com_ ` ' YARMOUTH COMMITTEE 39o/ OKHRD . , ..„,,,,,c,„„i:P4 Ft ,t;' .. . • . .. IIIII j' ' . '93 • N6.1V3 . P2 :13fa a ,,,� 1{ ..1.. ' 1— • 1UYiN Cllhh 3 if EASULf 1 / >' • (11 • . . (•111w, r; . •,.. , • .s%`,' thii4N . c st eH • \ 2 1 O (Z:2 p, ells f "Nonce ce o o :, t. ill e �• { . , CO/V o -yi I . j Cs iz, eS/ O m ! j1.• 1 ■• ' �N44. .. ..1 • n 'I f r :.4 - ! •'{ 0/444 w oz 4> Al Qs ;.0 1. at .a 1!. p DL 4. / %titan ilk i A roc' II I {' I. Z CD a y, " } ', Z 1126 '4 •i +J+ AI I ., . • r13 g ocr -1 ik 13 jii7 II' Olt • pdd3 i1rp „J , • / 0 ' D O t. , , ;:'1 •'1 LONG , 4 i1: : ., a POND ! . . .. 0