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Home My WebLink AboutBLD-93-733 (PS 10) Y,. „ Q7G/'Le $7#neu #/0 p� l93 > .-Et ?ha 4,s T o TOWN OF YARMOUTH otc� 1/al/n O ,CI 'Hj teMATTACHE 5 s�,4o..,,�o•$0' Application for a Permit to Build No. 733 UPON FINAL APPROVAL ci 30 '9.3 MAP (6'7 LOT 4/ FEE MUST ACCOMPANY THIS APPLICATION. DATE 19 73 The undersigned hereby applies for a permit to build7/3a#13 according to the following specifications ?/o o/G 1. Name of property owner ra lWII D E lUlCvr/f p. R w Tel. Address 11 'd(p 7-9 'hMn t ` Mr 2.Name ofArchitect(ifany) (J1Ifi it 4 /fad, RD '7tc Tel. a -S2Orr a Name of builder CC 1L ' # - AA[__ 'ddress RST 9c4cze fr flfrtfiiFi Pa 4. License No. O'1,Q30-6-. Tel. 0l7- 8341-052-r /'' 5. Name of Mason -10164( F l('t- C. "ey ddress ft _ 139' Mae/2- /4f 6. License No. 03781 Tel. F't{r- 3NIl 7. Construction address AK ever Flood District 8. Date of subdivision Approval plain zone G Zone a-4'O 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE Cortgesi , Cam Type of room No. 10. Multi family 0 af •`. sc, BLDG _ S tit) t -'.-dc- / 11. Commercial 0 / 97 /4 .,-,- c7 /' Kitchen 12. Other C"eland / p Dining Rm. 13. No. of stories (� - n o Living Rm. .` Bed Rm. C3 14. Foundation — Full /HaIf1O C awlfr'Slab O t Bath 15. Materials — Wood CH"Cement I"Other 0 f Deck 16.Type of heat — Oil 0 Gas WElectric 0 Other 0 I Closed porch 17. Garage — 1 0 2 ❑ v Family Rm. Sun room 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 fee 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 25. H.I.C.R. No. LOT RELEASED BY Signature PLANNING BOARD Add ess ?fl rime 'Yr Date if/LPZeaa /11 a2 cd E ` : BUILDING PERMIT APPLICATION SIGN OFF AP?LICA?.T: Clearwater Resources Inc. BUILDING PERMIT //: 617— ADDRESS: 858 Plain St . , Marshfield TELE. NO::83470585 DATE FILED: . BLDG. SITE LOCATION: off Forest Rd MAP#: 67 LOT//:P1 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. c ' 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: p l ^� 1. WATER DEPARTMENT , . DATE: 1 �1 I4' 7 N/A: 2. ENGINEERING DEPARL• NT: t. DATE: N/A: 3. CONSERVATION: ,dwr 4 DATE: f 9n N/A: 4. HEALTH DEPARTMEN fterla * Mani ' LA DATE: q I a-7 1 3 N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: '�C/ DATE: SEP 2 7 1993 N/A: 6. PLUMBING INSPECTO (ej.//f-( A�/_ [�(/LATE:9—d.7.- 49 3 N/A: 7. FIRE DEPARTMENT: 'let DATE: 5 --. 5141 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: 'IR) - MDS s1tj , ti• si.+LW; r 1 It cis(. oo BLM/89 TOWN OF YARMOUTH • BUILDING DEPARTMENT . CONSTRUCTION SUPERVISOR FOR`! • ' PLEASE PRINT: ' • JOB LOCATION: off Forest Rd . • NUMBER . STREET VILLAGE OWNER OF PROPERTY: - Town of Yarmouth CONSTRUCTION SUPERVISOR: - John 'Ryan 042325 617-ft31.1.-n5R5 NAME LICENSE NO. PHONE NO. • ADDRESS: '858- Plain' St .' , Marshfield, MA 02050 • . LICENSED DESIGNEE: S . - (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 •UPERVISE THE CONSTRUCTION, RECONSTRUCTION, ALTERATION, REPAIR, REMOVAL OR DEMOLITION INVOLVIN' THE STRUCTURAL ELEMENTS OF BUILDING AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE - COg1ONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, I• NOT THE PERMIT HOLDER BUT ONLY A SUB- CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. 2.15.3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY HE BUILDING OFFICIAL IN WRITING OF THE . . • • DISCOVERY OF ANY VIOLATIONS WHICH ARE COVERED BY TH: BUILDING PERMIT. 2.15.4 ANY LICENSEE WHO SHALL WILLFULLY VIOLATE SUB•ECTIONS 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 THOS2 PERSONS ENGAGED IN CONSTRUCTICN,' RECON- STRUCTION, ALTERATION, REPAIR, REMOVAL OF Da!OLITION S REGULATED BY SECTION 109.1.: OF THE CODE AND THESE RULES AND REGULATIONS. IN THE EVENT :AT SUCH LICENSEE IS NO LONGER SUPERVISING SAID PERSONS, THE WORK SHALL IMMEDIATELY CEASE UNTIL SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPARTMENT. -•• - I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER E RULES AND REGULATIONS ,FOR IICENSING CC:t- STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1 1 OF THE STATE BUILDING CODE. I UNDERSTF_;: ' 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 wh ch meets the require-^:encs of Matt-1527.... . ' •. Yes ? _ ; No ❑ If you have checkedlel. please indicate the type c:verage by checking the appropriate box. _ _ -'-- A liability insurance pc:icy 0 • Other type of: .idemnity 0 -- • Bond 0 •-"--- -- - . • OWNER'S INSURANCE WAIVER:t am aware that the rcensee dc•< net have the insurance coverge require:tv . Chapter152 of the Mass. General Laws. ana that my signature cn r:s pe mit cglica:Ian wanes this reCuiren ert. . . - Check one: . •wner0 Agent 0 ' Signature of(Nile:cr Goners Agent SIGNATURE, 1 BUILDING OFFICIAL APPROVAL: ~ 7==-•c COMMONWEALTH OF MASSACHUSETTS pci= • . DEPARTMENT OF LNDUSTRIAL ACCIDENTS ' 600 WASHINGTON STREET • JamesearlobeBOSTON, MASSACHUSETTS 02111 • • Comm ssione WORKERS' COMPENSATION INSURANCE AFFIDAVIT I, Clearwater Recntrrrec Tnr (I icensce/permi nee) • with a principal place of business/residence at . • 858 Plain St. Marshfield , MA 02050 • (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. ITT Hartford CU 5775 Insurance Company Policy Number [J 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: . - • 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 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(GLC 152,sect. 1(5)).application by a homeowner for a license or permit may evidence the legal sums of an employer under the Workers'Compensation Act I understand that a copy of this statement will be forwarded to the Department of Industrial Aeddenu' Office of Insurance for coverage verification and that failure to iecurc coverage as required under Section 25A'of MGL 152 can Icad to the impoiition of criminal penalties consisting of a fine of up to S1500.00 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 me. • Signed this a3Rd day of SP f t" , 19 1 993 se iPe �G Licensor/Permirtor