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HomeMy WebLinkAboutBLD-93-711 • _ . Y9.. Di5 5t W R33)a'art i r y, 0 _C i‘ • 5 oityit'9/l'{/43 s %,:wi tins Application for a Permit to Build Na 71/ °''r u 9/ic/ i' UPON FINAL APPROVAL 09" ao--93MAP //f/ LOT `/ :I FEE MUST ACCOMPANY THIS APPLICATION. DATE e{ ID 19 43 The undersigned hereby applies for a permit to build • /2%3 according to the following specifications 92%,3 1. Name of property owner 6-1c v• UA" W fcICI o Tel. :1gc!- 7727 Address t2 Tits nava ar 0.:qc i YAR 2.Name of Architect(if any) Tel. a Name of builder SuSSGt1 A. 64650v. se. Address 70 (or.)-- C ld6• ik. 4. License No. Oot 4 SL Tel. 36 Z- c{7Z7 5. Name of Mason Address 6. License No. Db14 52' Tel. 7. Construction address 12 `TASr,a.••i'. 0^ , Y8RJ Flood District 8. Date of subdivision Approval pin zone G Zone VC) 9. Private dwelling VI. Estimated Cost 9,14,13 DO NOT WR�ITE�IN THIS SPACE Act- 10. Multi family 0 •+r t 2�cwv.co /D� Gi^ ,� Type of room No. 11. Commercial 0 a- ZyY26 ' .7t3)13 Kitchen 12. Other ❑ — \e1X Dining Rm. 13. No. of stories 1 _ Living Rm. T6-3 ` c--z) Bed Rm. 14. Foundation — Full 0 Half Il Crawl 0 Slab 0 -">° ' °v fig' Bath ® 15. Materials — Wood' Cement 0 Other 0 -CI 1/4(. 0-3 546, Deck 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 40 No. of feet rear 131 No. of feet deep i oo 22. Size of building. No. of feet front 1.41 No. of feet side 24' No. of feet rear 2 e 2a Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from line or street 3 0' From rear lot line 50 r Side line 7 25. H.I.C.R. No. • logzabr LOT RELEASED BY Signature 1� s/ 4-lady. )s PLANNING BOARD Address 70 Ca CIA Drive- Date (c.A...ha 14 / 11^v1sc. 9/73/173 - - BUILDING- PERMIT APPLICATION SIGN OFF __ -2 A`PPLI!�NT: 11USS'tt A- �a-ikc-' _ v BUILDING PERMIT Il: ADDRESS: ?O 6^. .14/) ( J� DA✓L. GelA?TELE. NO. : 342'efZ17 DATE FILED:_ BLDG. SITE LOCATION: 1ZTASrn..,1&. P'., a/tJ MAP/I: //ZIP' LOT/I: 459' 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 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 R PECTIVE ORDER, PRIOR TO BUILDING INSPECTOR ISSUING THE REQUIRED BUILDING PERMIT: REVIEWED BY: // . ^ 9//0 03 N/A: 1. WATER DEPARTMENT ��tl/GL(G'C C [ln "5.2-7-1.0.-t DATE: 2. ENGINEERING DEPARTMENT: _ DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT � DATE: 91-7/41-9°.3 N/A: I,i�� STR AND/OR COMMERCIAL PERMITS r � / 5. WIRING INSPECTOR: DATE: N/A: 6. 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: (�t/Gf tP .. - t ,4 C&-i gicy q�'r ad au-a-en t- -7101,0.1 "Led- 6� GI 6-042_ • U //%N. Fount. ,Y 'Sacn.i /envice) cx.an. 4 g '54$ost, ?) /Zc'ccrs F�S £A4-0zcK Her 7O tcwz, 3) al N. V/ 1"/cit-Teo II w//cgcot. -21 Kintr.L emcmitr.n. / :3 O-c 0.-14-fii'Lt re 1927-60, Wn t.. F3a-rwire.. C41-tc 4 h4aust 7-0 CJxnr'c 5/D2 of eere f • But/89 3/`v C I , "'' eLTH COMMONWEAOF MASSACHUSETTS — ' • DEI AR T MEIv'T O F INDUSTRIAL ACCIDENTS :" 600 WASHINGTON STREET James J Camppeu BOSTON, MASSACHUSETTS 02111 . romm,sstoner WORKERS' COMPENSATION INSURANCE AFFIDAVIT I, 2C( 6:6,s5"-, Sr (I icensee/permittee) • with a principal place of business/residence at: 70 (0.1"-{-17- , c(-4 PA.,- (c-ltne,gJt AMf . : t (CirylState/Zip) do hereby certify, under the pains and penalties of perjury, that: [j I 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. [ ) 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 ContractorInsurance Company/Policy Number . . Name of Contractor Insurance Company/Policy Number • - - t Name of Contractor Insurance Company/Policy Number 0 1 am a homeowner performing all the work myself. NOTE:.Please be aware that while bomeowoers weo employ persons to do maintenance,construction or repair work on a dwciiina 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 Rants of an employer under the Workers' Compensation Act. I understand that : copy of this statement will be forwarded to the Dcparment of Industrial Aeddents' Office of Insurance for coverage verification and that failure to iecure coverage as required under Section 25A'of NGT_152 can lead to the impoiition of criminal penalties consisting of a tine of up to SI500.00 and/or imprisonment of up to one year and dtti penalties in the form of a Stop Work Order and a fine of S100.00 a day against me. / Sicned this 7-e�-�+`$1-. day of Se fife .lo-c'^ , 19 ¶ ___eatiej�l /,' Lice.-.!::::,:r7.2::::: Licensor;Permtr..,. • Suggested Affidavit for Home Improvement Contractor Permit Application 4 For omce Use Only NAME OF1CITY/TOWN Puma No. • +^,, , GUI M�\ Date • • 40 • AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application • 7 J • ' MOLL142A requires that the"reconstruction,alterat ion.renovation,remix,moderni7at ion,conversion,inprovement,removal,demolition. orconstruction of an addition to any pretesting owneroccuoled building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or budding"be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Con cle cl-io.. al— 2- ceetle. &,.4,ntet_ Est. Cos/re/20o Address of Work l2 TAS MQttii _ Ar ,'- Owner Name: Ua- (,M21GIe Date of Permit Application: 9//%j,Y I hereby certify that: • Registration is not required for the following reason(s): • _Work excluded by law _Job under S1,000 - 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: 1)443 Zoatela- St) 109e Date 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 • BUILDING DEPARTMENT • . . _-- _t-:.CONSTRUCTION SUPERVISOR FORM - . ' LEASE PRINT: , - /. OB LOCATION: .1 Z' AS Ina-h fit 111e. , • / a✓ro NUMBERST VILLAGE ET WNER OF PROPERTY: ' 4l.(_. - U&t) k' c (moi v ONSTRUCTION SUPERVISOR: gic3 . t( A- 'G-c c3— Do1QS'zt . LICENSE NO. PHONE NO. • )DRESS: • 70 Com-i-• 04 •DAVe--- • LOati,�qud. ICENSED DESIGNEE: (IF OTHER_THAN SUPERVISOR) NAMELICENSE NO. x.15 RESPONSIBILITY OF EACH LICENSE HOLDER: .15.1 THE LICENSE HOLDER SHALL, BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE S SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE UILDING• 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, RE1OVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE O'NONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB— ONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. 2.15.3 THE LICENSE HOLDER SHALL IiIM.EDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE ISCOVERY OF ANY VIOLATIONS WHICH ARE COVERED BY THE BUILDING PERMIT. 2.15.4 ANY LICENSEE LITHO 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 0 REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. . 2. 16. ALL BUILDING PER.IT 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 DaiOLITION AS REGULATED BY SECTION 109.1.: OF THE '•. CODE AND THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISING cAID PERSONS, THE WORK SHALL IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED CN THE RECORDS OF THE BUILDING DEPARTMENT. I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS .FOR LICENSING Ci'. STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF TEE STATE BUILDING CODE. I UNDERST2 THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDIN OFFICIAL. . INSURANCE COVERAGE: • I have a current liab:ity insurance pc:icy cr its substantial equivalent which meets the requirements ct MGLth.152 Yes X. . No ❑ It you have checked p'ea__ irc.szte the type c.:ergc by checking the accr ,_riate bcx. A liability insurance pc:icy C:her type of :..cernn:ty 0 Ecnd 0 CWNET?: :NSURANC—E WAIVES: I am aware that the :..ensee deet ^. t• of •:•P the in. ccvercge recaree .. Chaster 152 ct the Maes. General Lows, an: :net my ag _._re cn perm:: cn waives this requires_.._ Checx este: C'.vneri: Agent 0 S.;na:L':e cl l.'wner cr U«re;s Agent PLOT PLAN ` ,4 • a FOR LOT #` ' • Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) Well ro ) 7 (lot. . . ./3/ ft. rear) Abutter'sI Abu Name T+ I Nam Lot n 5 Q clC 1 • Lot n ©J REA YARD , If this is a • ' • If 1- corner corner lot, '21 . .ft. • corn write in name i . • �- wri of street. • • I Piot_ t- • nam • ) o, ..othe o cu Istre 'a •i SIDE YARD . SIDE YARD • HOUSE 23 FT. r� /i sc." :YTc • I y _ N d ar /� 4. , 0 SET BACK • • / • . 3o ft. 1-1 • • n 7 (lot to ft. frontage) .. \ / 12 Ths "aribt Or AU f•-• ) MR \ / \ / (NAME OF STREET) . f / • \ / \ •Inform a on- ( /'' / \ Supplied by SS Cy-3450'^ / ' \ • z* Eo 'Cd ifEte�/ unid -- r •o3� aaHxo z61 'fid robf �+� C� s 331iiwwoo Hinova�Ib rY»Q:H'93a' P 'J b sU)bg vet N3 a3noaaad� 10191 CLERK 8.Joiliti Or TRE �f1 r/ YY7 : r• p�}Jo. ,,,,QD/� u�yM L yfnoWac� . , . v�.o1 . . '1hL70 SMt'7 tu , oa ,y./.. (74.(74. W01 . paJu0D (1 (/MoyP Ay/19 ; +°yt At 1p;0 T At 1. 7,0-YS/O0S21,. /Puqd hfIV/!W at!rip Q/111; : -vaJ(r pJtPvf{ poo/s ? t/ u/ .fv S/ 4•77/ r/chc cro u/v oyr �iro.rqi - y1 • .......-7.7.,..1 �a 4 % ' Q �b'o ��/ S . 5 ° w 1�� //� 1 'V IN �?� CA) IL • Cv v ;, Q 2,vavg a/ n 1' • 1• . • / 1 �� I N n C70t:I• 97 . , d oz[6 . . Y�(�� . vo Ipud ;. . OP/C/ j V�' ii • 5 y's-00 0� S• $•���, r 0 6 - . 1 ' A 4 N Application to I ,� Old King's Highway Regional Historic District Committee r� f ,� in the Town of Yarmouth fora 3 e �� ��rip - -CERTIFICATE OF APPROPRIATENESS •7 Application is hereby made in triplicate,for the issuance of a Certificate of Appropriateness underSection 6 of Chapter470, Acts and Resolves of Massachusetts.1973,for proposed work as described below and on plans,drawings or photographs. accompanying this application for, . — • CHECK CATEGORIES THAT APPLY: • .. =o 1.Exterior Building Constrtiction: ❑New Building 4Addition ❑Alteration ' ' . rte-= m Indicate type of building:❑House: (Garage- 0 Commercial ❑Other - o . .R C) 2. Exterior Painting: ❑-^ ' -' " • • p„-<' C m 3.Signs or Billboards:❑New sign 0 Existing sign ❑Repainting existing sign —4,3 • 'tZ, 4.Structure: ❑Fence ❑Wall ❑Flagpole ❑Other - { 74 n b m (Please read other side for explanation and requirements). • ' c-'~ '2 TYPE OR PRINT LEGIBLY DATE—HUf l4s7 at f clef 3 ADDRESS OF PROPOSED WORK I a ` ixI ASMANr4 le 1me ASSESSORS MAP NO. 114 • OWNER GIe'm11 4 SL.c.ran 1l � VA/lCkLt • ASSESSORS LOT NO. C if HOME ADDRESS 12 - IchSwwnic& Rive • TEL.NO. 394"-17a7 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way.(Attach additionalalsheet if necessary). . 'I c�+b-cl k . 4 t,r,'1MA -6o1ine1Itj t lusn,ohltt Ir. 1ovta)ct k Stlsc,... t-a, r+.v.e jrw - t 1 t ctSr,.+let, nr ..CAUL I Lucille- Be: -Onarat v ants )-1111 2i. (AJesin,,ns-ivt. t*O , O1473 TOINA) CC rACM01.171-1 ( . tt F,tz A �n-1 AGENT OR CONTRACTOR CI Irl l6SO / Gli6COnl C,frt'sTratUrrit} TEL.NO. 3C - 3009 ADDRESS 70 at therm, CLutt JJR - CU VN0St. .€ • 13 ox I1?S, (" rns-1aiJle 02430 0,a11rksS • 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). t o- P,L(1tb nn1 AIM cI-t . muuo CA-a GIMRGG (ft MATH eY/s), i4 IttME Signed c-C226 Owner- { State oelow line for Committee use. FCPPROVED�"✓% Received by H.D.C. IA GiUUlii WM)AIUEE • yp % r-},// , OKHRD • Date $/ h 3"The Certifi ate is peril)b C '' ?-'411 • �' Date %// � I a I Time ';ZSi /{ -:ter`/J l/b./ ✓.// /p�� /� .,�e-=' --i--- • j F _� By a/ ,----.7, f ;. f l ', / ' .. . ,/, , ..9� • ) Art-attic IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal per:cd proviced in the Act. ='iso?rcv'ec ❑ Please return to: Yarmouth Historic District Committee Town Hail, 1146 Ht. 28, South Yarmouth, Mass.02664 Yarmouth Old King's Highway Committee • SPECIFICATION SHEET 3 9L (Submit 3 copies) , / • APPLICANT (OWNER) : 6(-En/i3S Nr}Ro/t1 . VAN VVI ICKL[ FOUNDATION (18" max. exp. ) : trot PC1) COn)c2Et CONCRETE/OTHER SIDING TYPE: LM%t1Tt Georg. SK,aULes ,,, acetic- a 666Le 'S +be COLOR: To M, it H Ex,sT$ `bY x (.p 3EVELa. St-b1 Ct cLAP(}kAp.b CFRcM CHIMNEY (indicate brick/stucco/woodfaced) NA ROOF MATERIAL: ASPHALT" SHW4tESPITCH: 7 (mon' Ex15i)144 COLOR: Mint, x � e ,s-nti (7/12 minimum) RccF L'"'e� SH,u4Les WINDOWS (grilles required) --Indicate sizes if not listed onfelevations: 3 6/e To M ;MN EY SDMc HCMG aV X .7/b DOORS: 2.. SIZE: 2.' b" x 6 r g,, COLOR: W HcTC TRIM: (all windows & doors trimmed 1x4/1x5) COLOR: wtl,TE SHUTTERS (woodCrinyl) MIVtCH �x,S77�c� COLOR: SLACK GUTTERS (wood fIuminum Ta MYr,ttf E 1C/s fIAl C7 COLOR: 4 h i TE GARAGE ZOR& z. SIZE: 4 x �7 COLOR: w H tT! o LUQ.. STAN WRIDOS DOORS: NA SIZE: COLOR: �g U YARMOUTH COMMITT� SKUIGHTE () T ONLY) : N c TYPE/SIZE: OKHRD COLOR: 0 17% . . DECK: N SIZE: COLOR: ` - 1 FENCING (max. ht. 6 ' ) : N A- STYLE: COLOR: . (show layout & running footage on site plan) ADDITIONAL INFORMATION: Cpr?A6G" iv G (3t11cr w Mt4j-r -f - L"frsrwK' 1-)eME, so As TO Blab a) Li is rr wA ALWAls NOTES: Color chips required. Outdoor lighting, electric meter and landscaping--show on site plan for new houses only.