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HomeMy WebLinkAboutBLD-93-716 - of*YAk 9/ZO 4 •mss, s � o Y TOWN OF YARMOUTHog ' 91�f 9s r I Jo ".,.,. i� y 1) �,"4 �5 1 Applica//t'on for a•Permit to Build �No., -116 UPON FINAL APPROVAL .. -pa i -7,3 MAP, 7 LOT eg 3 ' FEE MUST ACCOMPANYTHIS.L-pari APPLICATION. - ` 4 - DATE" -I/1/S' 19. 3 ' ' The undersigned hereby applies for a permit to build ,_-�' . ,, gA1RY)93 according to the following specifications ' ' . ' - 1. Name of property owner` 'tlah Yid' tr,.ACw L. // '44741473%e/-D >.Sb Address /1-( s,ceiVi' )/0 - - bt,hyt 2.Name ofArchitect(ifany) 4h4— Tel. 3. Name of builderGt1i/c'/ase• " t/i7 �1Address -Pi der 7Z . , , d 4. License No. OZ If /72- Tel. 7-)S - 7/C3 5. Name of Mason /LPri 'a— Address 6. License No. Tel. `/ 7. Construction address /4/ dr c/e'Y7Flood r , • District a Date of subdivision Approval plainlazone 13 Zone R5-9-C 9. Private dwelling 07 Estimated Cost 'CLP DO NOT WRITE IN THIS SPACE 9-/ 6-93 S ho.,dc Type of room No. 10. Multi family 0 69, no, d`O or - 11. Commercial 0 il ch .-,,/`__ i9)fi Kitchen 12.Other ❑ Dining Rm. 13. No. of stories Z �•�v Living Rm. 14. Foundation — Full Ernalf 0 Crawl 0 Slab 0 / d ' pd O Bed Rm. Bath 15. Materials — Wood Ia Cement 0 Other 0 s' ��L Deck /6)(14,2 j 16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 ❑ 2 ❑ Family Rm. 18. Swimming pool - Size Gr Gaanraggeem 19. Storage shed — Size Shed 20. Stove — Wood 0 Coal 0 Alterations 21. Size of lot: No. of feet front SS' No. of feet rear / CO • No. of feet deep 373 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. l o t 3 -g N n LOT RELEASED BY Signature Jfv5?47lrf ' 1\/PLANNING BOARD Address �s/Ti+' 7 Date S. /C1'Y12flr i 144 a 2 Q.41/ 1 res S//tha TOWN OF YARMOUTH „ - _ s • BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM . • PLEASE PRINT: ' . `''� JOB LOCATION: / ! ' M)// /S41.—' .--i CS 4-i1 NUMBER, ' 1 . STREET . . VILLAGE OWNER OF PROPERTY: 't Ji�i1 n '/r!f arrr/. • 4CONSTRUCTION SUPERVISOR: • I9 `1rqlf4n /9 F-7�, _ c—"- � k)� 'J2 �7S � • • NAME . •" LICENSE NO. PHONE NO. - ADDRESS: . iJ i', /-)ii'' >7a ' .S: 1/9 tn'`r 44 ' %L(",-. 0 al—a)/ ' . / 1 Y LICENSED DESIGNEE: . r4 kyje_. . • (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 ' COMMONWEALTH, 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 • 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 IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPARD 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 UNDERST?_;: THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. . INSURANCE COVERAGE: •.. m • ?;- I have a current IiSbility insurance policy or its substantial equivalent which meets the requireents of MGLtth.152, . Yes No ❑ If you have checked yes. please indicate the type c:verage by checking the appropriate bcx. -.-1:::;-''' '"- . ' A liability insurance pc:icy D". O:her type of:.idemnity 0 ••- - Bond 0 - •• •f • OWNER'S INSURANCE WAIVER:I am aware that the s censee dc_i not have the insurance coverage required:y Chapter 152 of the Mass. General Laws. and that my signature on tris permit ::clic:tion waives this requirerr:er.: • _ • Check one:• - OwnerD Agent 0 S,gna Ura or Corner a Oornet s Agent (-7 SIGNATURE: )Rath744 JJ BUILDING OFFICIAL APPROVAL: PLOT PLAN . FOR LOT Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) ® . Well r • I (lot 75- ft. rear) Abuttor's I Abut Name I I Nam Lot v •1- iii Lot ll REAR YARD If thisisa • f- 5 /% Ift corner lot, - ft. I corn •write in name • �I writ of street. I - name d)1 .othe • a o sire w s ro ^' • • • SIDE YARD SIDE YARD •0 20 FT. 0 HOUSE 0 1 FT. • IN 4 1 iq . SET BACK • • ft. t a., i p 1 cy • (lot /So ft. frontage) \ / \ / \ / (NAME OF STREET) • / \ • •Informaticn / \ Supplies by / • • • - -DEcc Is N6T Td EXcczt.L • Son A -ME Sit>3-73E (1.E, NO )fit ti&1J6 )S hUN=) 1-}6v%C ¢ /O O' �- • E'A gTD,ST TO Br l4-Prrz -roomed - L 466ED To thW St 1DI E- 06, ic- 7)&1c- 7YrF 2k& ib" ov ¢• • I O sT 4 / . . le Lino BEAM 2.6", ��'X Oxy Pm � may. fXrsr/'S e.SPhA ' • • /./1 ,i� EYhfrVT 'o ��/,' ;jjj ., % 1 /�' i to P�J�Ev Cb 13 OFTE- 32t0 rev ??bra Cb IN tJotner ra IABIS FA-ss 5c4LE yet":7_ < poen • tdiC • 4 .. V ti /jams 1 ' N q �� AM-T E7LEED 3o" 7n, , I zra• soisn I._ . 1b 'lib- _� 8 •'ON ¢ i / !9 F cS1PRDF 1 X1h7Eer I /G '� • I I o • � il • f 15 o TP 1A5= 12'• ± 53 c, ab - I - eo to ' :F—e.-K TO TO? • 9xbVT 3FfM . 1 - ,� S. a ' ,4 /TOOTW E,s (lo,1Xyg,rl 1 It.lI 1 yiibes J 'of�d5� 17 zK— //I • Tom 2' :l/6;14;6 :.?E-3r- 2oz PLs,9S4JTT� ST. . (15i7AJ " 2CGZ- 70 �� CoVg..e6-'D -}9SS 11 U , WV- bVAtGt.J Zry r, DE�.e"V4 56-41.-e-- ' PO ` ' _ _ COMMONWEALTH OF MASSACHUSETTS t.--F P . DEPARTMENT OF INDUSTRIAL ACCIDENTS r . 600 WASHINGTON STREET • James,: CamOoer, BOSTON, MASSACHUSETTS 02111 - ;,pr;misstoner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • 1, (AM 1‘044/1 /1 87c o6C-- 7I'• - (licensee/permittee) • with a principal place of business/residence at: . ?e,.fix ->7Z S-vYca- n u1% Rita, . o&o° s' (City/State/Zip) do hereby certify, 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 lam 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 D I am a homeowner performing all the work myself. NOTE.Please 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(CLC. 152,sect. 1(5)).application by a homeowner fora license or permit may evidence the legal statist 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 Insurande for coverage verification and that failure to;entre 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 against mc. Signed this /-6—t4 day of Stilt , 19 9 3 • .nset Perrn:z et. / Lieeasor/Perms-or Suggested Affidavit for Home Improvement Contractor P.ermit Application • - ' ' For Office Use Only., r. :: , 310 CMR 10.99 Form 2 DEP Flee No. A• a • (ro be provided by DEP) • Commonwealth Oily To ; YARMOUTH • =' •E- of Massachusetts "772 t Applicant WILLIAM H. ELDRIDGE, SR • • Determination of Applicability Massachusetts Wetlands Protection Act, G.L. c. 131 , §40 and the Town of Yarmouth Wetland Bylaw From Town of Yarmouth Conservation Commission Issuing Authority To William H. Eldridge, Sr. John & Susan Packard (Name of person making request) (Name of property owner) Address 7 Circuit Rd. . West Yarmouth, Address 14 Hollister Smith Yarmnnth MA MA 02673 This determination is issued and delivered as follows: C by hand delivery to person making reouest on (date) 'x by certified mail, return receipt requested on September 17 , 1993 (date) Pursuant to the authority of G.L. c. 131 , §40, the Town of Yarmouth Conservation Commission has considered your request for a Determination of Applicability and its supporting documentation. and has made the following determination (check whichever is applicable): Location: Street Address 14 Hollister Way, South Yarmouth. MA n7671 Lot Number: 1. E The area described below,which incluces all/part of the area described in your request, is an Area Subject to Protection Under the Act. Therefore, any removing, filling, dredging or altering of that area requires the filing of a Notice of Intent. 2. C. Tne work cescriced below, which induces alf'part of the work descnbed in your reouest, is within an Area Subject to Protection Under the Act and will remove, fill, dredce cr alter that area.There• fore,said work recuires the filing of a Notice of Intent. Effective 11/10c9 2-1 :..,-7....(ti - . 3. 0 The work described below, which includes all/part of the work described in your request, is within ! • the Buller Zone as defined in the regulations, and will alter an Area Subject to Protection Under the Act. Therefore, said work requires the filing of a Notice of Intent. . This Determination is negative: 1 . 0 The area described in your request is not an Area Subject to Protection Under the Act. 2. 0 The work described in your request is within an Area Subject to Protection Under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. 3. t The work described in your request is within the Buffer Zone, as defined in the regulations, but will not alter an Area Subject to Protection Under the Act. Therefore, said work does not require the filing of a Notice of Intent. 4. 0 The area described in your request is Subject to Protection Under the Act, but since the work • described therein meets the requirements for the following exemption,as specified in the Act and the regulations, no Notice of Intent is required: • Issued by TOWN OF YARMOUTH Conservation Commission Si. re 41 j a/� y/� .CAS /k f�4 This Determination must be signed by a majority Conservation Commission. On this swot-7e17-,.74(*lay y of �4le J 19,2 , before me personally appeared ya-. P. vma�rr c�✓i en.: , tome known to be the person described in, and who executed, the foregoing instrument, and acknowledged that he:she executed the me as his/her tree act and deed. N ry Public My commission expires This Determination Does not rebeve the adohcant from Complying with en other adplicable leceral.state or local statutes.ordinances. by-laws or regulations.This Determination snail be valid for three years form Inc Cate of issuance The applicant,the owner.any person aggrieved by this Determination,any owner of land=acing the lane upon wnicn the prcccsed work , ts to be cone.or any ten resioenfs of Inc city or town in whin such land is located,are nereoy notified of tneir rich;to recuest the Department of Environmental Protection to Issue a Superseding Determination of Apoilcaosity,proviomc me reouest is mace ov cert:lie:mail or hand delivery to the Depa^,mea:.w;:n the aCbrc;nate filing tee and Fee Transmittal Form as provicep in 310 CMR 10.03T wnnin ten Gays from the oafs of issuance of this Determination.A tipy of the request shall at the same lime be sent cy car:iliac mail or nano oenvery to the Conservation Commission and Ine t hcen:. 2.2A BUILDING PERMIT APPLICATION SIGN OFF APPLICANT: Nirg„, rRi/(4my/�� BUILDING PERMIT (/: ADDRESS: it( yo/1 4.7#r • Nay/ . „rig. TELE. NO. : 199 D7D: St DATE FILE /93 BLDG. SITE LOCATION: , yN t✓. MAPI/: 3 7 LOT//: /rf9 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 LYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS, MARSH LAND, ETC. IIEALTII 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 DEPAR' NT: DATE: N/A: {3 CONSERVATION: Ij awespr DATE: erg 3 N/A: C� 4. HEALTH DEPARTMENT A, DATE: 0N/A: 'IIUST' 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. c^ COMMENTS:0t bG-)1 SL'cr 5 i I31-/Nr Cra, Pt rges, Olt genre C1.t r PSIL d# 124 GA Ta /??zc vn er4- /lucre Fito'r /()rt /rim. 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