HomeMy WebLinkAboutBLD-93-725 /
$c -TOWN OF YARMOUTHr eosin rW .
V,"k �4)16Ce ApplicationYor`a Permit•to�Build No. 7C14 C9
UPON FINAL APPROVAL / MAP J0) LOT E 13 •
-FEE MUST ACCOMPANY THIS APPLICATION. DATE 9 /F — 19 93
The undersigned hereby applies for a permit to build V-R1/
according/ to the following specifications / r
{�Y. Name of property owner YeLA�✓AI (.0 7* ilei ✓7r/L �/a 5.,3.?
Address 0 '-f 1 cr, r°t( 1-A ore, ti Alla-PLA-11‘pour
2.Name of Architect(if any) Tel.
.3:t4ame of builder, 0Z-P Address
cit.-LI-Cense No. / 'e. !Li Tel.
5. Name of Mason / AYLP d • && •ddress Rc r; ✓n /r-a-tr n,n
I car-iv r o - ad it
6. License No. Tel. )1,10-7:�struction address -� ! `T p ph I- 2.A3 y,p T
Flood i tract
8. Date of subdivision Ap�coval plain zone Zone I— yd
9. Private dwelling L9'/ Estimated Cost ` P• D1�NOT WRITE IN THIS SPACE
10. Multi family 0 7, or7 c o-Q3 Pt?ac r ,/o' �-' Type of room No.
Jhe/43
11. Commercial 0 Kitchen
12. Other 0 176 % F Dining Rm.
13. No. of storiesd ,2____/s— Living Rm.
Bed
14. Foundation — Full 'Nall 0 Crawl 0 Slab 0 yj 0 p,roip
Ba hRm.
15. Materials — Wood IICement Other 103 z Sit Deck
16.Type of heat —/Cail 0 Gas ErElectric El Other 0 Closed porch
Family Rm.
17. Garage — 1 le 2 ❑ Sun room/sx a.- /
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 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 From rear lot line Side line
t-ZS. H.I.C.R. No.
LOT RELEASED BY u 411,!__ _, . • ch/,,
PLANNING BOARD Ad• - .s /�/�
Date �% . 0.7,G 7.Y
BUILDING PERMIT APPLICATION SIGN OFF
APPLICANT: /114,0141 ' +.7).../40.478:14,,..1 1BUILDING PERMIT Il:
ADDRESS: / tj1'j, 4#rr •tf ELE. N0. : ' J4A. S,tj,....DATE FILED: p/�€0„3
BLDG. SITE,,LOCATION: 34117 /c?s' -" r Plf:' 5 - LOT#:t/3
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: DETER�irepo � C LQg'�AR p LABILITY. ; '
ENGINEERING DEPARTMENT: DETE IN1S c flog J7�A4 FQ ,4?4 tING..AIV) 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
KaiET$.
HEALTH DEPARTMENT: DtTEIES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E. : REQUIRE-
/� NITS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES.
FIRE DEPARTMENT: /�DyTER . COMP,LIANCE.TO STATE AND TOWN REQUIREMENTS FOR PERSONAL
/r,1 .w. ."• ctr `t .Riff 1 &&ION, I.E. , SMOKE DETECTORS, SPRINKLER SYSTEMS,
THE FOLLOWING DEPARTMENTS MUST F, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR
ISSUING TIIE REQUIRED BUILDING PERMIT:
REVIEWED BY:
1. WATER DEPARTMENTy/ DATE: N/A:
2. ENGINEERING DEPARTMENTriDATE: N/A:
3. ,CONSERVATION: 0 4 n" DATE: N/A:
EALTH DEPARTMENT/ is DATE: 7-.1 / - q ? N/A:
/
''US RIAL AND/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR: / DATE: N/A:
6. PLUMBING INSPECTOR/ DATE: N/A:
DATE: N/A:
7. FIRE DEPARTMENT: /
I
PLEASE NOTE ,.t
ALL STUMPS AND/OR BRUJ4II 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:
s/cc( 70 , et- ga- 71 s J ad ' h- . s' f-''C'w. s ,Qcrc.1"-.1-'.-4 •
a s s 4v-w..,d•-. pl,--tot . !/
15Gz6- 1 fr.n.tirm- -rt gj&od-
n K ro-F
3 Mi N. *'.%rl-q `, 71 A/6= s /°'.WCS1 ' �rCaec> ,9.v<r.s<C.c«DF
• t 7
/ C1
�� 4 ,.
BLM/89 G� '/
qK •
THIS STATED Uo (or U) VALUES OF ANY ONE ASSEMBLY,SUCH AS ROOFING/CEILING, WALL OR FLOOR, •
MAY BE INCREASED AND THE Uo(or U) VALUE FOR OTHER COMPONENTS DECREASED,PROVIDED THAT
- THE OVERALL HEAT GAIN OR LOSS FOR THE ENTIRE,BUILDING ENVELOPE DOES NOT EXCEED THE
TOTAL RESULTING FROM CONFORMANCE TO,THE STRrED Uri Zor U) VALUES. •
e ,
t/,9 /4 O,: / 7' . • •
ENVELOPE ALLOWABLE U0 (PER-TABL.E 3109.1
Lw 0.08.)+(A,J0.65.1+(A„r,0.401+(Ana 0.0331+(A„.0.05)+(A„wp 0.081 = Allowable
//Sit,jrt•"` Artr i&•0 /11.91/ /,c,
/fix 0.03•)+(ax 0.65•)+Citi .0.40)+fix 0.083)+ i�x 0.05)+(fix 0.08) = • Ill
• 2 ,1911 Allowable Per Table 3109.1
.
ELECTRIC RESISTANCE HEAT U-VALUE WALLS = 0.05 U-VALUE WINDOWS =— 0.40
•
ENVELOPE ACTUAL U0(USING ACTUAL�VyALUES OF DESIGN OF ENVELOPES)
•
LwUwl+(A,:Un)+(A„0150 ( 3 11n_� _ r____ wri = ACTUAL
/6S1 IV OP. MP S4,7 gab
( k xs + /Lx !j )+(txa + I( Ao x,oriv)+(L?D x.etx)+C&x . ) = /i979
lV1.79ACTUAL
COMPARE VALUES •
THE VALUES FOR ENVELOPE ACTUAL MUST BE LESS THAN OR EQUAL TO THE VALUE OF •
ENVELOPE ALLOWABLE TO PASS
•
•
77;t s= FAIL
,
O:1.813RS1CH4a.032 4 of 5
i'
TOWN OF YARMOUTH
• BUILDING DEPARTMENT .
' CONSTRUCTION SUPERVISOR FORM
' PLEASE PINT: ' • 7
JOB LOCATION: 141T.delliay ' 494.. fir- f'
` 4, alr
NUMBER , . STRE T • . . VI AGE • ,
OWNER OF PROPERTY: ' eLANPA/JW bin, fiti,t7 t 2�
CONSTRUCTION SUPERVISOR: • •,„,"4172.4, �'- ' /A' ✓ s '.`
'1o2 '
NAME LICENSE NO. PHONE NO. • , .
ADDRESS: S-,fy)/C • . ' / q
LICENSED DESIGNEE: �( K
•
(IF OTHER.THAN SUPERVISOR) NAME LICENSE NO.
- 2.15 RESPONSIBILITY OF' EACH'LICENSE HOLDER: .
2.15.1 THE LICENSE HOLTIER SHALLIBE•FLTLLY' 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 . .
r -
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
COts4ONWEALTH, 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 D E:OLITION 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 IMIEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED
- ' ON THE RECORDS OF THE BUILDING DEPARTMENT. • '
' I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR .ICENSING CC:1-
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSEA:::
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
OFFICIAL. .
•
INSURANCE COVERAGE: • • . .
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGLth.152 .
Yes ❑ Na ❑
If you have check-edits, please indicate the type coverage by checking the apdtcpriate box ::-..•••:: ;.1.'•.:
A liability insurance pciicy ❑ O:her type of :.idemntty 0 •• Bond 0 2--- - •
•
• a • NER'S INSURANCE WAIVER:I am aware that the rcensee deer rot have the ins • nce coverage requires.5y
r ter 152 of the Mass. G era: Laws, ana that my signature on this permit :train, 'an waives this requirement .
/1 i • eek one:
! Owner Agent 0
•
,Ura of w er or
OA er s Agent
SIG URE: • BUILDING OFFICIAL APPROVAL:
r,
•
Suggested Affidavit for Home Improvement Contractor Permit Application
- Fos Office Use Only - NAME OF CITY/TOWN
Permit No.
Date
A//^_ AFFIDAVIT
,T " Home Improvement Contractor Law
•
Supplement to Permit Application
•
MGLc 142A•requires that thesreconstruction,alteration.renovation.repair.mod.ernization.conversion..inprovement,removal.demolition.
or construction of an addition to anv preecistingowner.ccunied building containing at least one but not more than,four dwelling units....or
to structures which arc adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other
requirements.
•
Type of Work: -- S4,//1.cnyrt7 "a,i) 4$i;4l4ecfc.✓ Est. Cos -- - -
Address of Work /V Tit-d✓ffy Lepicy�etiT
Owner Name: c /041-A-.P4/�AI Tem / ' /r ee
•
Date of Permit Application: 9 •• >a 9 3
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
V.-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:
Date Contractor Name Registration No.
OR: •
Notwithstanding the ahoy notice, I hereby apply for a permit as the owner of the above property:
DD t Owner /e
•
t _1
tCOMMONWEALTH OF MASSACHUSETTS
�
_ DEPARTMEN''T OF INDUSTRIAL ACCIDENTS •
L , ' 600 WASHINGTON STREET •
aures Camooeu BOSTON, MASSACHUSETTS 02111 . •
Comn,ssroner WORKERS' COMPENSATION INSURANCE AFFIDAVIT
(licensee/pc ittee)
• with a principal place of business/residence an
(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
[ ) I am a sole proprieror 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 o Contractor Insurance Company/Policy Number . _
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(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 Insuring;for overage
' verification and that failure to secure overage as required under Section 25A'of MGL 152 can lead to the imposition of criminal penalties
consisting 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 5100.0 ' v against me. /'
Signed tht it 4ay of 7.101f-ZA , 19 q C
Licensee/Pe:mu:et. LicensoriPermirtor
Lor `9 , T 3
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0. F444 APPROVED
YARMOUTH COMMITTEE
OKHRD
•
Nom-- 7WE PR:/srEe.ED 6`/G/Nflt of ba.vava
WNosc -t7AAlp AppeaaS eN Ms-s DRAw/.rCS Mere-Er-EVAr/o-v, awn> on/ Assc-n6D >TPA,
-W444 as-esspo.vl/ete ,c12 77/6- J✓ptrtV/S/CN
AvD enar,F.ear,e.v or o.,anvcr/eAl .V CERTI FI ED PLOT PLAN
-Inver Ae4,204vioC w'nt 7N6sE LYN'VS
F N 77 � 77/C Mat
LOCATION YAEA-toury / '9Ass
• SCALE . /''3O' DATE J4Y2¢/997.
PLAN REFERENCE .Q/-`/NO Zara,"
SN0.1-1A a'/ APL4n/ / E NlooDS/DE /??A',e
(/onEJ SNC., fjND . r-e•CQED /'V
,i.s+u,� PL.8..e. -?bG A : -1
te •
a* ;; or •,'^4 . . .
.�"1. :• \ .}42. lou7t/ /tri /4 cNG l,,q.2O �/yS,2
re_ :e. Vn r)'..:•- .
i1( t<-L;. ' I CERTIFY THAT THE $(.77^! ..... eu^/o9TIP!�.
pTED
./ ~* - AS SHOWN HEREON AND THAT IT CONFORMS TO THE
ON THE GROUND
/ cmc . . SHOWN ON THIS PLAN IS
��6^`,r�yp� SETBACK REQUIREMENTS OF THE TOWN OF
de ,'� sui;� . ..ARA: el./7K WHEN CONSTRUCTED.
�iiv�rt+ i DATE a-4yA.t /7Z7
PETITIONER: SPot'7Z W/1/9z bri Zvc. -Peririo/vagaF.
REGISTERED ND SUR YOR
Application to
��..�' 1:Cl ty� ty Old King's Highway Regional Historic District Committee
" 11 in the Town of Yarmouth fora 3q v V
,:_`"4JL --)' CERTIFICATE OF APPROPRIATENESS
Application is hereby made in triplicate,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470..
Acts and Resolves of Massachusetts. 1973.for proposed work as described below and on plans,drawings or photographs
accompanying this application for:
J
Q
CHECK CAT¢GORIES THAT APPLY: *-. W
1. Exterior Building Construction: 0 New Building Addition ❑Alteration tz-,`a'
Indicate type of building:❑House ❑Garage ❑Commercial ❑Other $u r✓r2oor.�7 m rn
C;
12"-- W i4 e-
, 2. Exterior Painting: 13Ire re-, ^nn -to C-„,
3. Signs or Billboards:0 New sign 0 Existing sign 0 Repainting existing sign aJ ti 0
4. Structure: 0 Fence ❑Wall ❑Flagpole 0 Other 7= z? rr-
(Please read other side for explanation and requirements). v c NL:S S
TYPE OR PRINT LEGIBLY DAT-I —o�
tom( rrzorl� /2/ .
ADDRESS OF PROPOSED WORK h [Awl ASSESSORS MAP NO. '74Sj'r
OWNER 90 L!}NDA f it 0i 1/4 /Ica'drew ASSESSORS LOT NO.E/.,
: HOME ADDRESS I`I r/1-o rM+•7 I-4AtE1 YAP ou.ntr sver TEL.NO. 3C - Ta.aa
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public
street or way. (Attach additional sheet if necessary .
40 542441/4 t-�1EN4C/�i4FiAN /3A(.14 19 Re AGtFE PA..L NELEAJ Loa1G Yfn,orth LAM/Cale),
J
r e-CAte /rs ao ratpe h/ LAAIer (hat) .
t 9iiaacn .l.aa / Tni'?trot l 4-r.e. r.4nnir-4e-s-e-e /
AGENT OR CONTRACTOR O I44/G(1$r FAA'r &7 — S-FLre TEL.NO. 3 e a - 9-tom•
. . ADDRESS 14 T?mood, L}wa-; LJ Aetmoa Vitro VT-
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). --��
4 ( APPROVED 0,CI---------
•
YARMOUTH COMMITTEE
_... �J /�/,HRD
., ,i Sign:. add U/
caner-Contractor-Agent
a race below brie for Committee use.
Received by H.D.C. •
AS AMENDED PER REVISED PLANS WI 4/12 .ROO? PITCH. •
`
Date ' /I-I tY3 • The ertificateishereby_,-/ •-/,.r -• ` Date <.-r / /y% e
Time ..-6. 1' 1/ /7 / %
-
3c . /
? B> co �.
.
•
••::-. d ❑ Fh1PORTANT: If Certificate is approved. approval is subject to the 10 day appeal per:::
previced in the Act. -
: !.W:rcv'ec 0 Pease return to: Yarmouth Histcnc District Committee
T:•.an Hall. 1146 Ht.26.Seth Yarmouth,Mass.02664
OLD KING'S HIGHWAY REGIONAL EISTORIC DISTRICT COMMITTEE w
oV
+ SPECIFICATION SH=ET
yliv4DA
APPLICANT'S NA`1 -0 1..1-14 l4ua4Z, > ECEIV6 et
'93 SEP 10 A9 :17
FOUNDATION: ell IST,:/t- C.oskattjt SACT foxj3WINONNEOF 3MAl OLOR NA
ADD S Foe7iNGs y8" 'Dcpjtf
SIDING: R -DGeps2 s/f.,04tE Cut o0D) COLOR: tdai•crioL
CEnDIEY: N�4 COLOR: "/4
ROOF MATERIAL: ASei4ALr 5RiAJOES PITCH: 3 11.4#
`# ` COLOR: M pert-14 To
n, ,,,A zi►E Gxs 6T. -c tkiS7ZQC 44°F
It .3 FR,.v r
WL\DOWs:-" .ru1t a WINDu.J cAsessencc Owu3) SIZE: 41(4 - ,t SSDd tem-u• .uDC)
A• Sw,Alt Dead WiNDohis AZ' Gameit StOir'oP-Doan. 57(t-
TRDI COLOR: Lam. :ra-
t
DOORS:Pp m- K (
G . 1 S SDC 4f.✓t�J6) 4 siod Snirw q Cweop)euu9 COLOR:
SHL'i-TEES: Njil N\.$PROVED/COLOR: NJA
YARMOUTH COMMITTEEII
GLTERS: M a9"4 L OKHRD COLOR: IA- t re
DECK: yy`A, SIZE: AP' COLOR: AO
G:_:GE DOORS:. NIA- SIZE: si/A COLOR: NII,-
STORM WINDOWS & DOORS: ✓ A; COLOR: a'-/,4
SKYLIGHTS (FLAT ONLY) 14. Class win/ SIZE: 3 Xt 4 COLOR: L.)14 rt /'Y
Wlep e.aSi'ueNfl
ADDITIONAL INFORMATION: .t4 iv2a'sM - lz' x /S' 13,4 < br a d vim-`s i7'C
5 L, I e add a
(5EG DRa wino cJ Fac /S cine. 4 07 le 4 Coi$T7ater o#V . atm"A 4;t) /14 iota
W Dit_ PAfner Fa'/t.i K-etn
9/83:.1