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Home My WebLink AboutBLD-93-703 ,oF'YAR U/'� Lv.� I/��/Q} ir o it TOWN OF YARMOUTH • NATTAC C , " $` Application for a Permit to Build No. '743 �4Otin�nevsri+�,; App 1 UPON FINAL APPROVAL 04 -' 3 MAP S LOT - Ick FEE MUST ACCOMPANY THIS APPLICATION. DATE <9- ((c 19 9a) The undersigned hereby applies for a permit to build 9//e9,3 according to the following specifications 1. Name of property owner %Via2ta czY9 U Tel. Address f.►t;VR O Se) YA2otbtA-4k 2.Name of Architect(if any) Tel. 3. Name of builde u ,.< ,ddress k C' t.sg .31seswtCll ca"' 4. License No. C3t2'ZR Tel. 472)II- -14C4- 5. Name of Mason Address 6. License No. Tel. p EA Construction address ChC.0 \A et en1/4 S'� �aISKrsv:_k\N Flood District 8. Date of subdivision Approval plain zone Zone - - l-'4a 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE T e of room No. 10. Multi family 0 23Cst m^ 7c,i, c i 11. Commercial ❑�� U Kitchen 12. Other ❑ L�^� GC✓ 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 Deck 16.Type of heat — Oil ❑ 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 I 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 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. tl0 (+"{-1 LOT RELEASED BY " Signa ' e .f. C- , N ' its Vlk - CI PLANNING BOARD Address` A. Cross Cot Date \--k 0...kW teS.n .rnA \ WAG a oZfay,c) TOWN OF YARMOUTH • BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM • LEASE PRINT: . • JOB LOCATION: (4. �ZIiilia•VA• �PiV0)%"«(3L NUMBER ( � � STREET_ _ VILLAGE OWNER OF PROPERTY: • Vitt ' VVMcn�i5 �% • y32 CONSTRUCTION SUPERVISOR: , 65;941/4-1/4 L � RAkih C2SL{ • O3L2i --i .- qI • - NAME LICENSE NO: . PHONE NO. • • ADDRESS:. ,I CSOge 9v- • �Q.0 tctWOctV k 'Q OZ6'1 • • LICENSED DESIGNEE: . • • •• ' • • ' (IF-OTHER;THAN'SUPERVISORY ' 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 ' COir1ONWEALTH, 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 3E 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 ' TEE 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 TEAT 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 DEPAR1 ENT. • I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONSIFOR :ICENSING CC:, ' STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERST?.:: THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. . ,. . . • INSURANCE COV AACE: . . • I have a current ility insurance pclicy or its substantial equivalent which meets the requirements of MGL1Ch.152 Yes i1 . '; No ❑ If you have checked yes, please i trate the type c average by checking the apprcpriate bcx. •-•'''"";:•I'{i'' ;K';'. - A liability insurance pc:icy. Other type of ademnity 0 ••• • Gond 0 ;-•- :•••••'"•'-• O'NNEF:S INSURANCE WAIVER:I am aware that the licensee dc_' rat have the insurance coverage required ti • Chapter 152 of the Mass: GenerJ L-ws••ana tha: my signature cn tn:s permit::pficaticn watves'this requiren'er.: ' • Check one: Owner° Agent 0 ' Signature of Comer cc Owner s Agent • SIGNATURE: • • - BUILDING OFFICIAL APPROVAL: • N. • • . • -- _ Fr Suggested Affidavit for Home Improvement Contractor Permit Application ....... . ..... . For Office Use Only _ --__ NAME OF CITY OWN DatePermit No. l ct\j.a \A t ��,t a... . • AFFIDAVIT • Home Improvement Contractor Law .Supplement to Permit Application • MGL e.142A requires that the"reconstruction,alteration,renovation,repair.modernization.conversion,in provemen f,removal.demolit ion. • or construction of an addition to any preexisting owner-occupied building containing at least one but not more than,fourdwellin,units....or to structures which are adjacent to such residence or building"be done by registered contractors,with certain except ions,alongwith other-. . . _ . requirements.— - — - - - ..__ • r Type of Work: ..1. Lit kt•tc.4( t, • s ---: Est Co :�.�6� ' Address of Work 66 Cfl t_nit RA,Gs Owner Name: VUTA vomer-k•V 11j taILL-0 • .Date of Permit Application: l — R. el ?, � . I hereby certify that: • Registration is not regeircd 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: - (L-S3 \NV.eb,00,1 t1OWLS tly.k.rcv4• 114. WV 445;:t Date Contrallitr Name Registration No. • OR: • Notwithstanding the above notice, I hereby apply'for a permit as the owner of the above property: Date Owner Name • • Y .