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Home My WebLink AboutBLD-93-721 -- .oF•Yetk GI ili6/93 ; � r : TOWN OF YARMOUTH Oa re.' ` bit 73 �• MATTACM[ 5 �t csj,"'.„... ..5,• ./ Application4for a Permit to Build No. UPON FINAL APPROVAL / 2..Z, ,)AP G S LOT y-41)-- FEE MUST ACCOMPANY THIS A ICATI��Kk ' DATE moi` 19 The undersigned hereby applies for a permit to build 7 a, 923 according to the following specifications VP 9a 1. Name of property owner :Tat st196 19- C/#T� ehilipW & Te . Address ac) BASS MS 9�/`- RP . 2.Name of Architect(if any) *__ ____ Tel. „n a Name of builder a:4W neC I�h& Address 31-CWP dR2 Rte, r211t-j 4. License No. 0 4 7 CO C Tel. 7 2_ Crag 5. Name of Mason Address 6. License No. Tel. Qn 7. Construction address 579;#s d9 F ass 2 d et Let - lood L District off- 3.‘r8. Date of subdivision Approval plain zone Zone 9. Private dwelling 0 Estimated Cost ADO NOT WRITE IN THIS SPACE cam PEP. /O. o-o Type of room I No. 10. Multi family 0 1 T , — * /14/q-5 l/ 11. Commercial 0 -1) .)e— Kitchen 12. Other o — Dining Rm. 13. No. of stories .70,of Living Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 .. /0 • DEQ' Bed Rm. _ FAL Bath 15. Materials — Wood 0 Cement 0 Other 0 ��' - Deck a„ 16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch Family Rm. 17. Garage — 1 0 2 ❑ 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 - 7 No. of feet rear -7 rel No. of feet deep )7/ i 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 From rear lot line Side line 25. H.I.C.R. No. 10 22ri 6121\ LOT RELEASED BY Signature le 41 C PLANNING BOARD Address 3 � 1 Date PLANNING 1)Nlo4-4, /749 ' o �0 ;3 BUILDING PERMIT APPLICATION SIGN OFF APPLICANT: /9 � Y102"2" #7 (14,4 ' 7 I/ 9-C.41-164 /2BUILDING PERMIT 1/: p ADDRESS: 9-C.41-164 /2 lite //`--/�TEELE. NO. : ', ;S S r39 DATE FILED: J�/��/SJ BLDG. SITE LOCATION:0 a,/ 6.3400 p. TWC `0 MAP11: LOU: 4/G1-- 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, Z.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 TUE REQUIRED BUILDING PERMIT: REVIEWED BY: 1. WATER DEPARTMENT DATE: N/A: 2. ENGINEERING DEPAI ' NT: DATE: N/A: 3. CONSERVATION: h . rhe DATE: d( - '( N/A: 4. HEALTH DEPARTMENT A DATE: 9-/ 9.- N/A: 1#UST AL 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: • • y�if/q3 BLM/89 ��/�- PLOT PLAN { FOR LOT # 7 • • Indicate location of garage or accessory building Additions with dashed lines . Sewerage disposal (cesspool) a • well ® • • (lot /3 ft. rear) • Abuttor's # Abul Name Name Lot # Lot # REAR YARD ' If thisisa • &le Ift corner lot, ll • ft. corn write in name writ of street. I name •!— a .•othe • p o sere o • • • • to • Sojifi—YARD SIDE YARD • HOUSE • _ FT_ 0 0_--� _ FTo 0 •• H 0. (.re ., ti SET BACK • • • 62" ft' SNS (lot 11 ft. frontage) .. • \ // /5 /9'55 R-srdtf2 P t) / . (NAME OF STREET) . / / \ -Information Pelf PfrAd Ca 7/6"3/20-- / \ \ Supplied by TOWN OF YARMOUTH ' ' • BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM • ' PLEASE PRINT: t�G:. . //• JOB LOCATION: a ./ • I/J 5$ 0 12 ' • NUMBER- . • i � / , `n�T,REET j) VILLAGE . OWNER OF PROPERTY: ' dO ch' '1�- l�/'(�'r/' " /yf/v/ `� ^� 2 • CONSTRUCTION SUPERVISOR: $ ftsF(/t/ mit...inem 64? 23 • 2 7i ('-J7 NATE LICENSE NO. . PHONE NO. 'ADDRESS: 32 dt RD : . .. W. k4 ,'rodo 23 LICENSED DESIGNEE: ' . • (IF OTHER.THAN SUPERVISOR) 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 BE 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 L`_"MEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPART:ENT. ' • I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR :ICENSING CCf- STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTAN: • ' THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. . . . . INSURANCE COVERAGE: • • • ` `:*•.n. . I have a currennj liability insurance policy or its substantial equivalent which meets the requirements of MGLth.152 Yes k _ No ❑ If you have checked v_s, pleas e indicate the P,pe c average by checking the app:cpriate box ' "_' "' A liability insurance pc:icy E5 Other type of :.idemnity 0 -• Bond 0 - OWNER'S INSURANCE WAIVER:1 am aware that the licensee dein: riot have the insurance coverage required by Chapter 152 of the Mals. Genera Laws, ana Mat my sig-a:ure on r:s permit application waives this requirement Check one: • Owner) Agent 0 ' S:grature or Owner ccrOwnner s AAggye]nt ' / ,,/ SIGNATURE: Ofdier9( -fli 1..- Ar BUILDING OFFICIAL APPROVAL: • • =- COMMONWEALTH OF MASSACHUSETTS • D• EPARTMENT OF INDUSTRIAL ACCIDENTS >. � 600 WASHINGTON STREET James Campoe�; BOSTON, MASSACHUSETTS 02111 Cgmmz55ioner WORKERS' COMPENSATION INSURANCE AFFIDAVIT I, R QP' '►/ M cCg•v7l7 (licensee/permittee) . • with a principal place of business/residence an • 3 )- (112 tMR R/) bo '4 o 64 23 ' (City/State/Zip) do hereby certify, under the pains and penalties of perjury,that: [) 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: •• 1- . . • Name of Contractor Insurance Company/Policy Number.. . . Name of Contractor - Insurance Company/Policy Number -.. Name of Contractor Insurance Company/Policy Number . 0 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 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(GL C. 152,sect. 1(5)),application by a homeowner for a license or permit may evidence the legal status 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 Insurance for coverage verification and that failure to secure coverage as required under Section 25A'of MGL 152 can lead to the imposition of criminal penalties consisdhg of a fine of up to 51500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of$100.00 a day against me. Signed this / ' day of 1. , 19 5L3 thi it welt Licensee/Permir e:: • LicensoriPermiror Suggested Affidavit for Home Improvement Contractor Permit Application • For Office Use Only NAME OF CITYlf•OWN Permit No. Dale AFFIDAVIT Home Improvement Contractor Law • Supplement to Permit Application MGL e.142A requires that the"reconstruction.alteration,renovation.repair,modernization.conversion,inprovement,removal.demolition. or construction of an addition toanvpre-misting owneroccunied budding containing at least one hut not more than four dwelling units....or to structures which are adiacent to such residence or building"be done by registered contractors,with certain exceptions,along with other requirements. n ml Type of Work: � /f/O /)5(/(s Est. Cos 4O ) Address of Work di I'�rf/(lf IV Owner Name: (40e CA %jcin etz-,/ O Date of Permit Application: ///y/93 • I hereby certify that: 1 • Registration is not required for the following reason(s): • Work excluded by law 'nob 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. Signed under penalties of perjury: I hereby ap ;for a permit as the agent of the owner: //y 3 frim Rerileir /o77 3 Dare 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 . ... ... . __ _... . . . . . •.... . . .... 54 ss RI Vg NB130 35"le 75 R��q� 00, , IT APPEARS ABUTTERS 1 DRIVEWAY ENCROACHES ONTO LOT 42 , 1 \ * \ 2a0' ti LOT 41 304 — _- -=f{sc ij 5 5':�y29 a .5\1 -- _ __=- a LOT 43 Ce h,.--.4'=-- 11j DE'cx — — — - LOT 42 SB1305.5'x, 750(r- , 5oo'- - : N/F RALPH D. KELLEY NOTE'. PRE—EXISTING NONCONFORMING. RES. ZONE: "R40" This MORTGAGE INSPECTION Plan is For FLOOD ZONE: "C" Bank Use Only TOWN: _WA&vl/T$ _ REGISTRY OWNER: MATTBE„W,j—U..STAS DEED REF: _L'ERT_97CZ5911 -BUYER: _LOS>PK&_LANA_CILITIMEIG32 DATE: _7/22/t.2 PLAN REF: _kC_12644=4.J„____SCALE:17= ia___FT. - I HEREBY CERTIFY TO 1'MEO1111BE_IL_1LYFR$ . _ THAT THE BUILDINGC YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS °�� CONSULTANTS SHOWN AND THAT ITS POSITION DOES _1__ CONFORM tt TO THE ZONING LAW SETBACK REQUIREMENTS OF THE 143 ROUTE 149 TOWN OF _ %a5flJQIlTR AND THAT 4- MARSTONS MILLS, MA. 02648 IT DOES_1Y1� _ LIE WITHIN THE SPECIAL FLOOD HAZARDi. TEL• 428-0055 AREA AS SHOWN ON THE H.U.D. MAP DATED_¢/�2 .6_ P. FAX 420-5553 . .:_u i — •ane s 25001,5 0004 C • /IWi THIS FLAN NOT MADE FROM ANT UMENT 9061 BJS PAO a ;. ' A. •i` SURVEY, NOT TO BE USED FOR FENCES, ETC. 4 '8 - & (} 0 6 I i � sell& MISSIM NSW. 1111•111.11111010 • ■ ■ INS= NE - i- t V 4 _ IMMO IMINNEMEI ■ al MIES IMINNEM SIM ■ ■ W6-zi ' al\6-C y4020 ygao viloa''U'-ln J e - - - - 3 -