HomeMy WebLinkAboutBLD-93-713 0 t: of•Yqk C 74/93
, o TOWN OF YARMOUTH o 9
ce e6): i.ce�i50.- Application for a Permit to Build No. 7g
UPON FINAL APPROVAL I�' .� -� .Th-:-.) MAP ` 6'D LOT /9-c L
FEE MUST ACCOMPANY THIS APPLICATION. DATE 9 —//6 19 93 9/
The undersigned hereby applies for a permit to build I-on,
according to the following specifications • 7/1-o/'93
1. Name of property owner 7a171)."--A AA/ Yv/6nfer,E Tel.39$4784
Address2 Syqnevai
2. Name ofArchitect(if any) -- Tel.r
/e yr � elni144).1Gj
3. Name of builder :.i -ran a /.: ✓CuAn.ddress £+rvir_ €nar
4. License No.2) e 8 Tel. 92 2— 9C'R i
5. Name of Mason — Address
6. License No. — Tel.
7. Construction address ,2 -7gy'cc' 5 S. Ars/
Flood District
8. Date of subdivision Approval plain zone n_ Zone y
9. Private dwelling 0 Estimated Cost `'W ' DO NOT WRITE IN THIS SPACE
10. Multi family 0 /S-009-ao ode— % Type of room No.
11. Commercial 0 fa'xiy'Digt/< Kitchen
vinivc s,pplef- mt tC:ap Dining Rm.
12. Other 0 .1-7a,s. pelt.
Living Rm.
13. No. of stories
----/O ' 'lc) DO° Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath �,! ,,
15. Materials — Wood 0 Cement 0 Other 0 yQ P.S ri m id 01114 Deck g f S,s_ j
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 Shed
2a 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 Fj rear Kline '�� Side line
25. H.I.C.R. No. /007</0 Sao -- ',
LOT RELEASED BY Signature I -�/-/ /.K6h/r
PLANNING BOARD Address /e9C ,4/nt'z'u4r/ , %
Date e' n/n--4 44 02C a
BUILDING PERMIT APPLICATION SIGN OFF
APPI:TCANT: c7 Z2/ n,e.„-Atr2vXrane . BUILDING PERMIT Il:
ADDRESS: /4/ CT 4!/ Wrern44-1A a7l/lT TELE. NO. : A,4.2I- 5,.71 DATE FILED:
BLDG. SITE LOCATION: 02 Vd}✓Cdt MAN: G0 LOU: 22-C/
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 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: 1 ' DATE: I N/A:
HEALTH DEPARTMEI . U -DATE: 1r7 ) N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
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:
BLM/89 9//
COMMONWEALTH OF MASSACHUSETTS
=Es' DE'AR MENT OF INDUSTRIAL ACCIDENTS
600 WASHINGTON STREET
ear..c.e1; / BOSTON)M ASSACHI4EITS 02111
n:ss:ersr WORInRS' COMPENSATION INSURANCE AFFIDAVIT
_ .. amu._ - v —
°ieens&pc. cc) •
ith a principal place of business/residence at
•
io 3.r- NEa/7 -041A/ B crr,-n,i ,O'J el a c2
(CiryIStatc/Zip)
s hereby certify, under the pains and penalties of perjury,that. •
I I am an employer providing the following workers' compensation coverage for my employers working on this
gS7 LFt — Aran y C 'eV 2zn/ ite74,
.sur.:.:: Company Polity Number
I I am a sole proprietor and have no one working for me.
I I am a sole pr:prietgr erl corata?or homeowner(cite:one) and have hired the contractors listed 'ee::x•
'no have the following workers' c9mpensation insurance paider.
ame of Contactor Ins•,::ace Company/Policy Number •
1•H. J
:me of Contractor : Inswanc:Company/Policy Number
•
ame of Contractor Insurance Company/Policy Number
I ant a homeowner performing all the work myself.
NOi c Please be aware that While homeowcen who a_p(oy persons:0 do maintenance,constructioc or repair work on a
wefis e:not more thin three uaiu in which the homeowner also ruidu or a:the grounds appurta:ant thereto are not peneriiy
insiders:to be employers under the Workers'Compensation Act(CL C.1;2,se:.. 1(5)).application by a homeowner fora liccess
•permit msy evidence the lepal status of an employer under the Worker?Cc:position Act.
untras:r.d that a nosy cf this statement wiz be forwarded to the 1)9=m::tindurial Acddc nz'Office of insnrssee(Cr avcrq:
sine::fez a.c that failure to secure cove.--p as required once:Sec ion 29.et MGL 152 an lead to the i.mpos;t on of«en .:1
:rsis:-p et:fine of up to$1500.00 realer imptsonncn:of up to one ye::sac dr"•t penalties in the form of a S:op Wcri Orcc:an:a
or of S:{:::0 a day gins:me.
icon:d this llv day of Se Pr— • .19 /
ter l .-94.
c:as:e'7e:mit e: Lich...../Pcmirror ; .
t,
Suggested Affidavit for Home Improvement Contractor Permit Application .
For Omce Use Only NAME OF CITY/TOWN
Permit No.
Date
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGLa 1424 requires that the"reconstruction.alteration,renovation.renair.modernization.conversion.inprovement,removal.demolition.
or construction of an addition to any pre-existing owner-occunied 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: -: ,c/� -
-Est. Cost /S OU
Address of Work o: ela}.QL�//F 5% g}7
Owner Name: CR-ft /��G „"ftf /
Date of Permit Application: Vjd/9 t
I hereby certify that: -- -
- -- - -
Registration is not required 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. I42A.
Siened under penalties of perjury:
I hereby apply for a permit as t f the oy!
7
___ koieI' o ViO
ate Eom a for Name Registration No.
OR: '
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
Date Owner Name
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PLOT PLAN A. -7-e3ycE ` -
FOR LOT it v Yfra4/o1,7-0
Indicate location of garage or accessory building
Additions with dashed lines------------
Sewerage disposal (cesspool) ED
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Abutter'sliit. Abutter's
Name I Name
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