The URL can be used to link to this page

Home My WebLink AboutBLD-93-743 w:;. o Yq4 y a!'& /o///91 ',%**` s s`1o . TOWN OF YARMOUTH .,:. , , c tMIITTA . 7V--,e.,,z ,..ozio- Application for a Permit to Build No. UPONFINALAPPROVAL� �f - ' MAP Si LOT S—/co , FEE MUST ACCOMPANY THISAPPLICATIOF�: ' ' ' DATEOe-r• I 19 eel The undersigned hereby applies for a permit to build _ /b f// according to the following specifications '! ' ' ' 4 "'A ' :• tn. Name of property owner c Lr1 C 122 0 • (20 SS kg Tel.%)' 78 .L Address 010'•IlDILL RD nuht io HY),hc_ (MOO 2.Name of Architect(if any) ' ' Tel. t.-&Name of builder SV-hriv Address 4. License No. Tel. 5. Name of Mason Address 6. License No. Tel. L- 7. Construction address 4/0 Swiri /Moo/ ..&j 5(7 . Flood District 8. Date of subdivision Approval plain zone l° Zone ,Q SSU . 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE 10. Multi family 0 !� / 2-coo #. �g ate^- t__ Type of room No. 11. Commercial 0 .,.. Kitchefi / 12. Other s, ST /P /Pr') � , tK/ T, Dining Rm. 13. No. of stories //1z..— ?S.--;on Living Rm. / Bed Rm. 14. Foundation — Full C�' Half 0 Crawl 0 Slab 0 Bath 15. Materials — Wood ❑ Cement 0 Other U— Deck ` 16. Type of heat — Oil 0 Gas EvElectric 0 Other ❑ Closed porch 17. Garage — 1 I Y2 ❑ ' ( Family Rm. 18. Swimming pool - Size N\u - ( , GaSun room Garage 19. Storage shed — Size A) IP I 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 25. H.I.C.R.No. LOT RELEASED BY �gnature G _/- PLANNING BOARD _ Address a 7 /tee Date - .-- ' • / _. _ 0 . _ 0 TOWN OF YARMOUTH BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE Ct✓1010C42.I 1993 1•<JOB LOCATION L10 SC.v , cV FjQP_pOlc. 'P SO O+ nf2 rlo CA W.n NUMBER STREET ADDRESS SECTION OF TOWN HOMEOWNER" L1. (7N .(�Rpc5\ey n • --) ' _f.1iO At HOMEWORK PHONE r-a �G 51 RESENT MAILING ADDRESS /4)(:b )bin 170)9t • �U ?)1,toOlig la CITY OR TOWN STATE ZIP CODE THE CURRENT EXEMPTION FOR "HOMEOWNER" WAS EXTENDED TO INCLUDE OWNER- OCCUPIED DWELLINGS OF ONE OR TWO UNITS AND TO ALLOW SUCH HOMEOWNERS TO ENGAGE AN INDIVIDUAL FOR HIRE WHO DOES NOT POSSESS A LICENSE, PROVIDED THAT SUCH HOMEOWNER SHALL ACT AS SUPERVISOR. (STATE BUILDING CODE SEC- 109.1.1) DEFINITION OF HOMEOWNER: PERSON(S) WHO OWNS A PARCEL OF LAND ON WHICH HE/SHE RESIDES OR INTENDS TO RESIDE, ON WHICH THERE IS, OR IS INTENDED TO BE, A ONE OR TWO FAMILY ATTACHED OR DETACHED STRUCTURES ASSESSORY TO SUCH USE AND/OR FARM STRUCTURES. A PERSON WHO CONSTRUCTS MORE THAN ONE HOME IN A TWO-YEAR PERIOD SHALL NOT BE CONSIDERED A HOMEOWNER, SUCH "HOMEOWNER" SHALL SUBMIT TO THE BUILDING OFFICIAL, ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT HE/SHE SHALL BE RESPONSIBLE FOR ALL SUCH WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1) THE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH THE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGU- LATIONS. THE UNDERSIGNED 'HOMEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF• YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIRE- MENTS AND THAT HE/SHE' WII4,COMPLY W,ITH SAID PROCE' r S AND REQUIREMENTS. HOMEOWNER'S SIGNATURE - APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a curre liability Insurance policy or Its substantial equivalent which meets the requirements of MGI.Ch. 142. Yes El No ❑ If you have checked ym, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy d Other type of Indemnity 0 Bond 0 .. OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have-the insurance coverage required by Chapter 142 •f the Massrd6eral s, and thaUpy signature on this permit application waives this requirement. Sir10rCheck one: Owner 0 AgentX Signature of Owner or • er s A•-nt I • . • :._s e. is _ COMMONWEALTH OF MASSACHUSETTS JEPART.MEN''T OF INDUSTRIAL ACCIDENTS d' 600 WASHINGTON STREET James CampbellBOSTON, MASSACHUSETTS 02111 . Cornnssrone WORKERS' COMPENSATION INSURANCE AFFIDAVIT • 1, — 11(:-'72-: IO . C(2 n ss lc.1 (I icen see/perm i rtee) • with aprincipal place of business/residence an �/ p7b IA-DTc=L 12A Y)-U —)“.40 /a11W4rt)cr" at-talo (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. Ynflint (,rip)Dyates fluiura4/%/q/es-et ,Of • 1 c1000 ave Fr Insurance Company Policy Number [3 I am a sole proprietor and have no one working for me. 1 am a sole proprierCeneral contncto tr homeowner (circle one) and have hired the contractors listed below V who have the following workers' compensation insurance policies•. - - .. -- V-t2() N ) w tc1t �AilX3'�?1n y�,� g 1006 261 ? Name of Contractor . Insurance Company/Policy Number.. . • rtutlat✓ 1.— �ltstu • Oncc d , Name of Contractor - Insurance Company/Policy Number - :, - . . 110bte F)0((he o±ci 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(CL C. 152.sect, 1(5)).application by a homeowner fora license or permit may eviisnce 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'ofMGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to SI500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of S100.00 a day against me. ned this . ci (25A/ day of Or inhCre- , 19 93 -. `` / ' Licer•.see/Per.. :7:n: Li:ensor:Permt¢:. 1 • f • . V 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.I42A requires that the"reconstruction.alteration.renovation.repair,modernization.conversion.inprovement,removal.demolition. or construction of an addition to anv pre-existing owneroccunied building containing at least one but not more than,four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other requirements. _Type of Work: J QJtr.e C Est. Cost 1,9oo.oa £ddress of WorkL(D SUJS'-T R L?&* QcinO go, ( 1 Ptznou • • �.� v6wner Name: "k 6-12 C 0 O SSI Date of Permit Application: Ct XO13e e_ • f q 93 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law • _Job under SI,000 B ilding 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. I42A. Siened under penalties of perjury: I hereby apply for a permit as the agent of the owner: 1613 Date Contractor Name Registration No. OR: • Notwithstanding the above notice, I her ap ly for mit as th • 'er of the above property: )6111 - :-� Date Owner , erne