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Home My WebLink AboutBLD-93-715 4 ` .T 'o TOWN OF YARMOUTH o`. Y/�74� Ow-zit:*, I ' ... MATTAC�E 5 J i e6):1L.tt0515 Application for a Permit to Build No. 17/5" I UPON FINAL APPROVAL ed /'09-0 -93MAP $60 LOT S 't3 FEE MUST ACCOMPANY THIS APPLICATION. DATE 19 93 The undersigned hereby applies for a permit to build l-0 93 according to the following specifications 9/a-°b.3 1. Name of property owner 1:2u li Me. Hap Wive Te1.391r 0337 Address IR Out oS 13ouNaS 3l1-iut Snail% Y awA.04k 2.Name of Architect(if any) Tel. a Name of builder 1H►ke. L`\r C'us ked Address 7D Nun.*toStot Ave.. 4. License No. Tel. .3 98424_7 AG nth lass p . t% 5. Name of Mason Address 6. License No. Tel. 7. Construction address I S Ov+ a& BouSJS 11r51;e- Sov'1•k Y4vnous& Flood District gyp8. Date of subdivision Approval plain zone C _ Zone 9. Private dwelling 0 Estimated Cost O NOT WRITE IN THIS SPACE 7 Type of room Na 300 10. Multi family 0 '°}1) �a�_ Rot,/ 11. Commercial 0 Stir .r sehee'g- .�� & Kitchen 12. Other '$1 'tbr•?pp. 4- reosrv.w I.1 S Dining Rm. 13. No. of stories rla-TrP-S b 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 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 0 2 0 Family Rm. Sun room 18. Swimming pool - Size Garage 19. Storage shed — Size Shed 20. Stove — Wood 0 Coal ❑ 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 Na 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 r:,: •t line Side line 25. H.I.C.R. No. /0 39 247 �� LOT RELEASED BY Signature %%.//// PLANNING BOARD Address ) A N•/ 'ut, Date Seuit.. YosrM004L r ' • Suggested Affidavit 'lir for Home Improvement Contractor Permit Application a • • • roe pm,the Only. , NAME OF CITY/TOWN PermNa t, •YOrm,doI r� •• ..Date • . • • ..r • Ak•HUAVIT ' . Home Improvement Contractor Law . • • .. . • , . , Supplement to Permit Application • . • - • • MOLcS42Arequires that the'rcconstntctfon,alteration.renovation.repair.mafcrniration,conversion.inorovement removat,demotitions• oreonstructioh of an addition to any preccisline owner-occupied building containing at least one but not more than four drthine units....or •to structures which are adjacent to such residence or Nadine be done by registered contractors.with certain exceptions,along with other.,... requirements. • • . . . ••• The of Work: S'b.tp . 'Miro& • •T Est. Costaiao ttto ,Address of Work IS owl- a 136„.4.5 It. U 11'x . LO • YQ.vmo V' . e• , Owner Name:' .-Kuhn/ht. Har11V4r ' , , Date of Permit Application: Se I l q43 , t • 'I hereby certify that: • • ' • • Registration is not required for the following rcason(s): ! • ' _Work excluded by law • , • _Job under S1,000 • ' Building not owner-occupied ' ' Owner pulling own permit , • Other (specify) .. . Notleq ii hereby given that: • •• • a • •'.OWNERS PULLING THEIR OWN-PERMIT OR DEALING WITH•UNREGISTERED' t • CONTRACTORS FOR APPLIC?BLEHOMEIMPROvEMENTWORK DONOT HAVE . •'- ' ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL°' • c. 14.2A, • Signed under penalties of perjury: - kt I hereby apply for a permit as the agent of the owner: • • • � D p ' 11 Mike. CtkaG,0s\Cs/ _ oJga 1o' Contractor Name Registration No. OR: Notwithstanding the above notice. I hereby apply for a permit as the owner of the above property: • Dalt Owner Name • • memo DILE I10114VEbEkr tnt,. ;f'.0 ugb1F IMP?IhVEMENI INC. TO ituntington Avenuci ' SS. Ife�sl D itti. y,U' use ;WI/:): ;,.;- tT7 :t... t�f,':, ..ti =t ri • t BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM • • PL*ASE PRINT: • • • , • • c L .. • • JOB LOCATION: 18 Our ob..' 15onNd,g sl. a S0 V fl► •:14t.-tbi it,0 NUMBER WN . STREET VILLAGE -OtNER OF PROPERTY: ' rnv�inre. tks•w0.Y ' CONSTRUCTION SUPERVISOR: ('^A., meettuOtke� - /039 (24. 398-7.' 7'7 L NAME c. I1� • . 11 LICENSE NO. . PHONE NO. ADDRESS: 7 D HvN 1 ivo Ave . vov Ih \ iov 1h LICENSED DESIGNEE: (IF OTHER THAN SUPERVISOR) NAME • LICENSE NO. 2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: (nENitCO Haff IMPROVEMENT INC. • 70 Huntington Avenue 2.15.1 THE LICENSE HOLDER SHALL BE FULLY AND COMPLETELY R`SPOVSIBi FORS CY.L`tIatt .FOR?WHICH HE IS SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STAT 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, RE?AIR, 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 CC:e:ONWEAL:H, EVEN THOUGH HE, THE LICENSEE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB- CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. 2.:5.3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE DISCOVERY OF ANY VIOLATIONS UHICH ARE COVERED BY THE BUILDING PERMIT. 2.15.3 ANY LICENSEE WHO SHALL WILLFULLY VIOLATE• SUBSECTIONS 2.15.1, 2.15.2 OR 2.15.3 OR ANY ' . OTHER SEECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED; SHALL 3E SUBJECT `1/4-' TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. 2.:5. ALL BUILDING PELMIT APPLICATIONS SHALL CONTAIN THE NAME. SIGNATURE AND LICE3;SE NUMBER 0: 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 . G COLE AND THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISi:j SAID PERSONS, THE WORK SHALL I:_'EDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTE! ! ON THE RECORDS OF THE BUILDING DEPARTMENT. - t I -AVE READ AND UNDERSTAND MY RESPONSIBILITIES IES UNDER THE RULES AND REGULATIONS .FOR :ICENSIYG t S U :ION SUPERVISORS : ACCORD,;_;CE :CLT; SECTION 9 1 THE CONSTRUCTION I`• PROCEDURES 10 OF THE STATE 3UILDINC CODE. I U:;DEPS: T - .,S:cON OCE URES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE •3ULLD: OFFICIAL. , INSURANCE CCVESACE: • I have a r_;;^eracd;py insurance • Ye: pc:;cy or : subs:on:I l ec_reaient whicn meet: the a •'eGu:ren-erts •ct ;dCL'�h.I.52 It you have c,.ecxed_ :.,.e inc:ca:e :..e :The c7•rer- by _ _ e A Iiabdity insurance pt:c—y T C:..er type of 'noerrtn:ty 0 Bene 0 • C'NNER'c :4SL't ,;Cc WA IVER: I on: onto Inc: the :zonoce '7:7"7_-- _.eye :'a__. ,._..c:� L••.vs. ...c ..._. -y .. _ --.._ c..�e:=fie ret-::ec ':.� r�G N1 x714. Q .. , :: :. .. . .._... .. --_•._' `•.vz:�e: ..... :ec_::e-..._ :,_. e • . J • • • • Q In accordance with the pr visions f MGL c 40, S 54, a condition of Building Permit • / & Number Ig'oi.of? ,,,,k)4 %44hat the debris resulting from this work shall be disposed of in a roperly limns solid waste disposal facility as defined by MGL c Ill, S • 150a The debris will be disposed of in: • YaNMovi LOA cz.11 (Location of Facility) • • • ignature . Pe •T rp, icant • . S. ` ' • Date • • --- • • • 0 AFFIDAVIT As a result of the provisions of MGL c 40, S54, I acknowledge that as a condition of Building Permit "-se f. #trnber/g culg„.A � $f/all debris resulting from the construction activity governed by this Building Permit cul I be disposed of n a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. • I certify that I will notify the Building Official by Oct 17 /493 ('lvo months maximum) of the location of the solid waste disposal facility where the debris resulting from the said construction activity shall be disposed of, and I shall submit the appropriate form for attachment to the Building Permit. Seftil 1993 D to - ignature of Permit Applicant (P/ .V type the followng information) • Mike_ nc.C1us1Key — ^ r Name of Permit Applicant 1 1kerr4c.O HO Me. J t1roQttmots Firm Name, if any • 7 D ilowitnkeo, Aut. Soot YaPMOJik I Mass Address