HomeMy WebLinkAboutBLD-93-741 .o.1;Y4I Cr-216A/
' • -$ `- h o TOWN OF YARMOUTH oKF�� 4(torn
• MATTACM[ 1 .
ec,,< �•�0: Applic ion for a Permit to Build No. /PP/
UPON FINAL APPROVAL 61.36 •13 MAP f R G LOT .74 2-
FEE
FEE MUST ACCOMPANY THIS APPLICATION. DATE
The undersigned hereby applies for a permit to build 9/ 30/
according to the following 7/3specifications ,a/g3
1. Name of property owner ti, rri 4 7'?RAVV/S Tel. •
Address i 'f c. 2^ 4. 1-0A. 2D 138cr7an<r rti, (sec) e8'J- drN
2.Name of Architect(if any) ^1/41 Tel. ---
3.
3. Name of builder C-7 rot-,Y re:enos>ecc I Address G 7- "rt-7r c rtt"NC nom Pee
4. License No. 0 0 9 7 2-0 Tel. 7' 7 7 122 '2--
5.
5. Name of Mason I AAddress -
6. License No. ------ Tel.
7. Construction address ?7 Nor-, it?rtic7oCA re> >'r-7n
Flood / District
8. Date of subdivision Approval plain zone C- Zone _ R"� O
9. Private dwelling, Estimated Cost `ai P. DO NOT WRITE IN THIS SPACE
4-9-93 ode) f t z.. 61ti Type of room No.
10. Multi family 0 / c 9 o 6/b' /93
11. Commercial ❑ n. 0 . ' Kitchen
12. Other ❑ �9� ' �• 1�'� 3 C• crU Dining Rm.
13. No.of stories "
aa x--•
�d 'X ie 4 DSP. Living Rm.
14. Foundation - Full 0 Half 0 Crawl 0 Slab 0 ra-r. Cr-r) 6"' Bed Rm.
Bath
15. Materials - Wood 0 Cement 0 Other 0 Deck/d X 01 / /
16. Type of heat - Oil 0 Gas 0 Electric 0 Other 0 Closed porch
17. Garage - 1 ❑ 2 ❑ 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 No. of feet rear No.of feet deep
22. Size of building. No. of feet front No. of feet side No. of feet rear
;r
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.LC.R. No. /0y9Z7_
LOT RELEASED BY Signature r c:
PLANNING BOARD Address c �"' 77 ,,,A. 0 r,AtePCR
Date
,,e, e___.
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uJ14t'' .01dKing's Highway Re Regional Historic Distric ;Committee
.
- ;-•in the Town of Yarmouth for a
' - • CERTIFICATION OF EXEMPTION :
Application is hereby-made,'in'triplicate,for-the issuance of a certificate of exemption under Section:6 'and 7 of Chapter 470,
Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans; drawings, or photo-
:• ”
,graphs accompanying this application. s .'
, , ._ i . ;'0}- "^i,'r.•'• .'. iN ti
'.TYPE OR-PRINT. EGIBLYy .i_.'=5t;`''# ;t:{:: i .DATE ���-4 n 93 .
, > , :. :,c:J ; '
- "
ADDRESS OF PROPOSED WORK-
.ry /471.447 Its ick ,T75's7—
ASSESSORS OAP NO. 72 4
OWNER 1-7nrz(e 'knTz7:or,lS ASSESSORS LOT NO. -re 2--
" ON f " 0.2177- �csiSo , GS3 GS7r
HOMEADDRESS `7'G PolC roN ' Te,.D 1- h T Te-,.D TEL.NO. • l
AGENT OR CONTRACTOR ? 7 co.Try 12enob 'et.eTL5 • -. • -
ADDRESS Cr !Tv)" eerZCmr. e SMAS GPE6 0zef y TEL. NO. ' 7 7..-."1zat_
This application is for exemption of proposed exterior construction on the ground that:
(1) It will no: be visible from any way or public place.
(2) It is:within a category declared entitled to exemption by Old King's Highoay Regional Historic District Commission.
(Check applicable box) =r_ , .73
c r"
PROPOSED WORK: D_cr:bo and furnish plan of proposed work, showing lccati w
r nn IotEand. if•,an addition is involvec• thcw
ing location of existing ouildina. r4'' . z E' - , -,
T- • Q
REPcACehet. 'r > ec� / o X )2, . ="'Z :. .,-
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EXt5 ?'/rc ?e Cy_ hoe ✓6CerI) 7°'• n� UN$€7Zvlc." 117,5-
•) CON)i rtoN. Ws QstoPoi a '/7 'o rter- eve iY - AND
TzeP41cn •r'e i 'r Lr/ Prccss0rtc' TTcs,rc , ST-oCk,. .
Crc,,,Lc LJ/e.6 7s. A e rCTCCt to n rs'@ r Co ) e- ,y
ti/15 15 A II r rec.00r= DECk , f,r.,
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` '9e 3,.cK or 'A c •/97o fro/-te , to Vi sr lc �
C r ,szoj� r
Po a i. I r_ L17man e . G �J •
SIGNED 6/
r•Contractor• t
Space:vow line !o' Committee use.
•RTceived b3' H.D.C. Th ;tate is ,erebV �GFI�// "� — is '
y Date a/ Ici; A ✓ sli /�/��f.�/. ,� /
:Time _ /..07—:�er `
By �� ��r %ROVED dpi
c.ii:'
�! A. OKHRD A, . � '
Approved CT` V, The categories of work entitled to exemption are listed 1 n
Disapproved '0 the back of this form.
BUILDING PERMIT APPLICATION SIGN OFF
APPLICANT: P-i Carve/ Reh.Dece3. 'BUILDING PERMIT Il:
ADDRESS: •:/rt. n' e hrceTELE. NO. : f' 7 7 /n, a DATE FILED:t•s7n 73
BLDG. SITE LOCATION: rc % din nnrtis pock MAPI#: /aZG LOTH: -TCR
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 DATE: N/A:
2.,,ENGINEERING DEP,.. TMENT: DATE: N/A:
13: CONSERVATION: m'1`v DATE: 6 -/Q - N/A:
4. HEALTH DEPARTMENT / _ .4, DATE: 4'0./ r 4> N/A:
- I PISTR , AND/OR COMMERCIAL PERMITS J
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. anSACC//1,/,;(1r
^�-COMMENTS: 346%. I ?,U/LD Da,IG /a 6o n . - 0D40214;
M ��G-F,c '73 /�vse- ( otrLs�1 �!i/3v�
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eaomya
FCR LOT n �G2 sr r7 doncrrl)7Dcs.
. Indicate locate cf garage cr accessory building •
Additions with dashed lines
Sewerage disposal (cesspool) ED
Well
I •
1 (lot ft. rear)
•
kbuttor's I Abutter's
Verne Name
Lot if � Lot fl
REAR YARD
:f this is aIf this •
:orner lot,
631 t ft. corner to
ante in name write in
,f street. I name 'of
1z, c otherc.
•
0 ,o u sweet.
u Deck
J� J
4 y
SIDE YARD SIDE YARD
Aa+ FT. 0 HOUSE i54-1
4
1
SET BACK
30 + ft.
J :1
O C
( et f` rcntace)
�y Hanerc3 �DcK
\\ ! / ( (NAME OF STREET)
i
TOWN OF YARMOUTH
• BUILDING DEPARTMENT • •
CONSTRUCTION SUPERVISOR FORM
•
PLEASE PRINT: ' •
•
JOB LOCATION: 3'? /ion @ rc'S ,oct-
TrD //7 P
NUMBER - STREET VILLAGE
OWNER OF PROPERTY: ' t7nrtt C /CATLyesN iS
CONSTRUCTION SUPERVISOR: te. Tttr c l< Z7 10 rt- 009 7 P o f 7 7 /2,22-
NAME
2z2NAME LICENSE NO. PHONE NO. •
ADDRESS: G7- 71P-713E324,,N E l`/. s/l.PGe O,Zdn •
LICENSED DESIGNEE: $..r-•t
(IF OTHER.THAN SUPERVISORY 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, RalOVAL 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 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 E1OLITION 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`ENT.
I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR LICENSING CC:1-
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: •
I have a current liability insurance policy or its substantial equivalent which meets the require^unts at MGLIth.152
Yes . No ❑
If you have checked:fn. please indicate the type coverage by checking the ap=rcpriate box.
A liability insurance pricy Other type of :.idemnity 0 Bond 0 •
•
•
OWNER'S INSURANCE WAIVER: I am aware that the licensee does rot have the insurance coverage required :y
Chapter 1,52 of the Mass. General Lows, ana that my signature on thus permit :;plication waives this requirement
• Check one:
Owner] Agent 0 •
SIgnatura of Owner or Goners AgentA '
SIGNATURE: P 9 Co%'�/ BUILDING OFFICIAL APPROVAL:
StatZ.
ComCOMMONWEALTH OF MASSACHUSETTS
_ Zi.
P_
1/4�- /P DEPARTMENT OF INDUSTRIAL ACCIDENTS
` ''
600 WASHINGTON STREET
•
sanies Gamooer. BOSTON, MASSACHUSETTS 02111
Corn,sstone•
WORKERS' COMPENSATION INSURANCE AFFIDAVIT
I, Ftr Corrc7
(licensee/permirtee)
with a principal place of business/residence at:
•
Tr- 'r./Qcre-c.,ry e 77,111 Pee O.2G jy
(Ciry/Sure/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 CompanyPolicy Number
7 I am a sole proprietor and have no one working for me.
( ) I am a sole proprietor, general contractor or homeowner (drde 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 Numbcr
Name of Contractor Insurance Company/Policy Number
0 I am a homeowner performing all the work myself.
NOTE ileac 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(CL C. 152,sea. 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 eiminal 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
line of 5100.00 a day against me.
Signed this X C7;#' day of T/u,., , 19 93
Lice^!:_i?:...... � Licensor/Perm:-o:
i
Suggested Affidavit for Home Improvement Contractor Permit Application
For Office Use Only NAME OF CITY/TOWN
Permit No.
Date
AFFIDAVIT •
Home Improvement Contractor Law
•
" Supplement to Permit Application
MGL c.142A requires that the"reconstruction,alteration,renovation,repair,modernization,conversion.inprovement,removal,demolition.
orconstruction of an addition to any pre-existing owner-occunied building containing at least one but not more than tour dwelling units....or •
to structures which are adjacent to such residence or budding"be done by registered contractors,with certain exceptions,along with other
requirements. -
Type of Work: 'Pe CK Re rt-Gene v at. Cost )‘4;c7
Address of Work 8.7 //o fy a rz's ',oak RI,,
Owner Name: /`7„T, e )C„7ey„r, t S
Date of Permit Application: r -.r re 9 3
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law
_Job under $1,000
_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. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
57
Date ?tractor a e7 Registration No.
OR: • /
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
Date Owner Name
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: f " ce••'7 • ?O1,d!KinHighwayRegfonalHistorc'Dis..tnct .ommltteeM
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. *s.rr *-e• ,, .yq.i .rv.. .irP:»..•.._ ` '
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x'="' .i" ' inthe:Town'of.Yarmouthrfora -•
` CERTIFICATION OF EXEMPTION '
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_;;.Appiication..iiiii by;made, tr1licaie"„fo7theifiii.1 ceofacertificateofexerrt tionunderSection6`and.7.ofChapter"470«"'T _Y'
ere t �,;,.? �..._e.__.. . _ ,,. .,-,...... ...... .»..__.. ?- ,.�,.._.T....,,,v-,..,.. '
^*•Acts'and:Reioives ot,Massaehuseits;^1973,:as amended;for proposed wo rkas describ,ed,below,and orj plans,drawings,or•photo;;;;:;j:',
� 1
•
graphs accompanying this ap•ication:; , x
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r sT,Y1E OR PRINT-LEGIBLY „ 4 d <• ^F,w_a;' : '.St'; w x} rk,t'. 1w ', DATE'.s_.., ,,F{"."y .,. ,,* z'' r t`
;" s $ ,"f/oMQrtsibek ynPa'Ta :ASSESSORS MAPNO� ' a'4 ''
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ASSESSOFjS,LOT,NOt Z
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AGENT ORCONT.fl , Rf 1� T 6'oFf�y Tst1ebE4Q7 S
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ADDRESS _ l •
'NThis application,ts for`exempiion of proposed exterior construction on the ground that: `
{ _ a
will not ba visible from any'way or public place.
(2) It is ui,htn a category declared entitled to.exemption by Old KingsHighway Regional Historic District Commiss•ori
. t' ;(Check applicable Hihbox)
,:,PROPOSED t\0RK Describe and furnish plan of proposed work;showing location. on lot,and. if an ad...ion is involved;mat., , „
:,ing location of'existing buildingi0 , -. . ', ,
,1a,., KOfit;fric e/rr`Ern 7” r/,e ck.. .:./ o 3(.,.j .-
d '; '' CXt57rryC, ~.3?6'„Cr X IYA5 ' >eCn ED ' To 4 'AN UN5,SIzvs/I B- 0. '
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