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Home My WebLink AboutBLD-93-734 (PS 11) (tine S?i`TroiC #i 1 O rt/Z7/93 .61. 1 `r' df`FEW 919 9g 4. - :as- ti;. o TOWN OF YARMOUTH 0 44,�k, H "4 :` Application for a Permit to Build No. 74.351 UPON FINAL APPROVAL 7/' 3Oci'93 MAP to ' LOT P1 FEE MUST ACCOMPANY THIS APPLICATION. DATE '7/Z9 1973 The undersigned hereby applies for a permit to build T/5°/%3 according to the following specifications 3C 93 1. Name of property owner COOL e94- 7i&t9W p,Pete /Tel. Address f t`-1 to 2Q' `tt .tta•rhf 2.Name of Architect(if any) ( " ITflhif I 1-Fvv'.¢t2-0 Tel. a37-9c0 3. Name of builder 247 47t Recr ece!' vc Address 9St Ala Jr /T9,tPiFietn 44 4. License No. dKZ32. Tel. (oto 831,1 aSFr 5. Name of Mason ow F XCG4" Address RC 139 f{ o2 i leg 6. License No. 037941L Tel. c -3tiff 7. Construction address 0-f 4 6,a eir Icci Flood District cI_cid 8. Date of subdivision Approval plain zone Zone /` 9. Private dwelling 0 Estimated Cost / DO NOT WRITE IN THIS SPACE 6M-42ocan &Asst Type of room No. 10. Multi family 0 , At l Bldg_cri $// 6wri dGpG 11. Commercial 0 / W/gj , Kitchen 12. Other ol`fUU' -- , 17 , f Dining Rm. Living Rm. 13. No. of stories r .�e . Bed Rm. < . 14. Foundation — Full t4Half❑, •Crawl Er Slab❑ ' , i' i Bath 15. Materials — Wood S' ement 111 Other 0 Deck 16. Type of heat — Oil 0 Gas VElectric 0 Other ❑ l Closed porch 17. Garage — 1 0 2 ❑ 111 Family Rm. Sun room 18. Swimming pool - Size Garage 19. Storage shed — Size Shed . 2a Stove — Wood 0 Coal 0 Alterations . cf}4 21. Size of lot: No. of feet front See P 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 ✓m" PLANNING BOARD Add ss eR3 i/444 /J''r- Date Inn-RSIs I%e,& ,*/fr 42QS& BUILDING PERMIT APPLICATION SIGN OFF • APPLICANT: Clearwater Resources Jnc . BUILDING PERMIT 11: ADDRESS: 858' Plain St: Marshfield , MA TELE. NO. :617_834-0585 DATE FILED: • BLDG. SITE LOCATION: off Forest St . MAP!!: 67 LOTH: 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. 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: 1. WATER DEPARTMENT % q . DATE: °1`n..1 S N/A: 2. ENGINEERING DEPARTMENT: A DATE: N/A: 3. CONSERVATION: , iA��eDATE: q-7-— 73 N/A: 4. HEALTH DEPARTMENT -1r �i�l��►YiR, DATE: 11 )1 '3 N/A: INDUSTRIAL i/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: /.0 TE: SEP 2 7 1993 N/A: 6. PLUMBING INSPECTOR) /- ira ,TS' DATE: --9' N/A: 7. FIRE DEPARTMENT: Jf } (_ ., , DATE: Q'1/ 1.93 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. yy COMMENTS: �1Fh - P\6 )s S1'et'�z i Int s14L Lok +'D Re. (ems • BLM/89 TOWN OF YARMOUTH BUILDING DEPARTMENT • - CONSTRUCTION SUPERVISOR FORM ' ' PLEASE PRINT: ' t JOB LOCATION: nff Fnrpst St NUMBER . STREET .. VILLAGE OWNER OF PROPERTY: - Tnwn of Yarmrntth CONSTRUCTION SUPERVISOR: -John P . Ryan 6/ 9395 617-83rr 0585 NAME . m LICENSE NO. PHONE NO. • . • ADDRESS: • 858' Plaid St . , Marshfield , MA 02050 ' - . 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 LASS 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 PER`!IT 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 DE`!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 IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED • - ON THE RECORDS OF THE BUILDING DEPART:MIT. " ' -• • : - ' I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS .FOR LICENSING CCN- STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTA_:: 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 . i.' ":Yes ::.-• No ❑ -... -- , - - -•— • • - If you haver ked v,�s• please indicate the type a average by checking the appropriate box. • --' ' • • ' - Aliabilit insurance c:ic 0 Other -.... -. • -• - - • - - Y • p / type of :idemnity❑ Bond 0 . OWNER'S INSURANCE WAIVER:1 am aware that the licensee does 'ct have the insurance cover;. require:Sy. Chapter 152 at the Mass. General L-ws. ana that my signature cn is permit :cap:irticn waives this requiren-er:t - Check one: • Owner) Agent 0 Signature at Owner or Owners Agent • re i i SIGNATURE: 444 -t/ -' '1Jr - BUILDING OFFICIAL APPROVAL: / • ----- - - ---- - - — • r COMMONWEALTH OF MASSACHUSETTS ' efr, `c"J. DEPARTMENT OF DMUSTRIAL ACCIDENTS 600 WASHINGTON STREET amess BOSTON, MASSACHUSE11S 02111 • Campoei: Com t:ss,oner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • . I, Clearwater Resnurres Tnr (licensedperminee) • with a principal place of business/residence at • 858 Plain St. Marshfield, MA 02050 (City/Surf/Zip) do hereby certify, under the pains and penalties of perjury, that: (g 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 () I am a sole proprietor and have no one working for me. ( J 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 1 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 Insurance for overage verification and that failure to secure coverage 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 01 5100.00 a day against me. Signed this 093Rd . day of Sr, IL , 19 9'3 111 1LL/ • ,� icersee!Per. Licensor/Pal-mi-dr