HomeMy WebLinkAboutBLD-93-742 •
_,... .-- 'at•tiii.; 4 , /1/6/93
t r; TOWN OF YARMOUTH F�''' ginfri3
a .H alk°0, "` 5 Atlication for a Permit to Build No. 711R,
Pr'
• UPON FINAL APPROVAL 9 30 /cot� MAP _ 22 LOT A92
FEE MUST ACCOMPANY THIS APPLICATION. DATE 13 AUG 93 19 g
The undersigned hereby applies for a permit to build /7&93
a�ccc rding to the following specifications 9��/93
Vf. Nameofpropertyowner Residential Rehab Cntrs Inc, Gilbough Te1896-5776
Address 1646 Main St Brewster 02631
2ameofbuilder
ameofArchitect(ifany) n/a Tel.
Patrick J. Coffe •ddress 68 Timberlane Mashpee
4. License No. 009720 Tel. 477-1222
5. Name of Mason n/a Address
6. License No. n/a Tel.
V./Construction address 153 Run Pond Road S. Yarmouth
8. Date of subdivision Approval n/a plain zone B District R-25
9. Private dwelling 0 Estimated Cost "al' 4O NOT WRITE IN THIS SPACE
/a-LS-9:k%P 0. er-pryc— Type of room INo.
10. Multi family 0 • 1 $1000 ,. ; ivN C ir
11. Commercial 0 . ; ; / Kitchen
12. Other j croup REsi,dencer 35-' cro Dining Rm.
°-`1 t�' Living Rm.
13. No. of stories 1 AS; re) $A L Bed Rm.
14. Foundation — Full 51 Half 0 Crawl 0 Slab 0 Bath
15. Materials — Wood al Cement 0 Other 0 Deck _
16. Type of heat — Oil ® Gas 0 Electric 0 Other O Closed porch
Family Rm.
17. Garage - 1 0 2 ® Sun room
la Swimming pool - Size n/a Garage
19. Storage shed — Size n/a Shed _
20. Stove — Wood 0 Coal 0 Alterations
21. Size of lot: No.of feet front 120 No. of feet rear 120 No. of feet deep 115
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. /Oil 921
LOT RELEASED BY Signature Al" -P�//✓r/ • co
PLANNING BOARD Address Cr 'r { � K ger /
8QP
Date
f/6/93
.. !,..k }ds.
• If
APPLICA T: i . r•.h r!"�= � F.re R k C, (I ire. BUILDING PERMIT 1::
ADDRESS: • ;Hi r•� TELE' NO. :
' :�. -•c. -,F �`. � ` � S/77 /z2. 2 DATE FILL•D: l7n40c 93
BLDG. SITE LOCATION: / ✓ o Mr, P. u, R MAP//: .Za LOT/f: A 9A.
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 CO'Th1ERCIAL 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
1YPE 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 DEPARTMENT: DATE: N/A:
3. CONSERVATION: DATE: N/A:
4. HEALTH DEPARTMENT /, , DATE / fr 3 N/A:
;Is
D/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR: , DATE: N/A:
G. 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:
•
BLM/89
rf7� 2f// 717-5
•
• �+ • PLOT PLAN •
• FOR LOT # A 9a •
Indicate location of garage or accessory building
Additions with dashed lines
Sewerage disposal (cesspool)
, Well 0
I
(lot l AO ft. rear)
AbuLLur's I Abut
Name I Name
Lot ;i n 20 - . I • Lot #
• A9S
REAR YARD
If this is a • I.Z If tl •
corner lot, ft. come
write in name •- I ' writ
of street. I name
- a '.. othe
• 0 a) stree
� .. . . ro
4
SIDE YARD SIDE YARD
HOUSE
' ft 4, 0 ± FT • 0, o /5` FT0 ,
•
4- O 9 c, �! 4 •
Prep Poi CD I
RA p SET BACK •
•
ai�lNtL• .5-
ft. �,
S
I
I
(lot l ?t ft. frontage)
N /93 Kuno Tor. ) R a
\ \ i (NAME OF STREET) .
\ - • . •
/ Snformedion Py C'��
/ \ Supplied by /
TOWN OF YARMOUTH
•BUILDING DEPARTMENT •
CONSTRUCTION SUPERVISOR FORM -
PLEASE PRINT: '
JOB LOCATION: • 153 Run Pond Rd. , S. Yarmouth
NUMBER • . . STREET • . VILLAGE
OWNER OF PROPERTY: ' ' Residential .Rehabilitation Centers Inc. , 'Gilbough
CONSTRUCTION SUPERVISOR: . Patrick V. Coffey. 009720 ' . - 477-1222 '
. NAME LICENSE NO. PHONE NO.
ADDRESS: ' 68 Timberline Mashpee 02649 • .
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
COKMONWEALTH,. 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 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 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 .ICENSING CCN•
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 policyor its substantial equivalent which meets the requirements of MGLth.152
Yes g No ❑
If you have checked v_s, please indicate the type coverage by checking the aptrepriate box.
A liability insurance policy C3 . Other type of :.idemnity 0 Bond 0
•
OWNER'S INSURANCE WAIVER: I am aware that the licensee deer: rot have the insurance coverage required _y
Chapter 152 of the Mass. General laccp
Laws, ani that my signature en th:s permit lication waives this requirement
• Check one: •
Owner❑ Agent 0 '
Signature or Cuner or Goners Agent '
SIGNATURE: . • BUILDING OFFICIAL APPROVAL: 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
MOL e,142A requires that the"reconstruction.alteration.renovation.repair.modernization.conversion.inprovement.removal.demolition.
or construction of an addition to anv pre-existing owner-nceunied building containing at least one but not more than fourdwelling units....or
to structures which are adincent to such residence or building"be done by registered contractors,with certain'aeeptions,along with other
requirements.
•
Type of Work: ` c_CC'S5Ret,P' Est. Cost'/ o o
Address of Work / Ron/ pomp Rani' S. ynRy`7o✓ Yfjr
Owner Name: !L I?o✓ GH Cer -eR R R C l /roc
Date of Permit Application: /13 "a G 9 3'\ •
I hereby certify that: ,
•
Registration is not required for the following reason(s): •
Y Work excluded by law
rJob under 51,000
v 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 asthe anent of the owner:
!3 .r . 23 l'17 co / Or ;
Date Contractor
fl
n} Registration No.
•
OR: • /
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
Date Onncr Name
•
`� COMMONWEALTH OF MASSACHUSETTS
• DEPARTMEN''T OF INDUSTRIAL ACCIDENTS
"Cc 600 WASHINGTON STREET •
•
JamesCamooeu BOSTON, MASSACHUSL11S02111 , •
Comm•ss+over WORKERS' COMPENSATION INSURANCE AFFIDAVIT •
•
1 ' •.-1 f-
,
(licensee/permit-tee)
• with a principal place of business/residence an
(City/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 Company Policy Number
[ ] I am a sole proprietor and have no one working for me.
[ j I am a sole proprietor, genera] 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
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.
l 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 iccure 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.of S 100.00 a day against me.
-" 7-k •
Signed this t�� day of 00 C , 19 9 '3
Licensee/Permit-re; (-"7/7/
,,// Licensor/Permiror