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Home My WebLink AboutBLD-93-744 it` o TOWN OF YARMOUTH (51,16 3°194 k 0 0 k H 4 •*0$ eTCA " TTAC;IL ' Application for a Permit to Build No. 7W ° I , kr/� UPON FINAL APPROVAL U MAP � LOT 64/3 FEE MUST ACCOMPANY THIS APPLICATION. DATE SP f t .29L 19 93 The undersigned hereby applies for a permit to build `� /1>//191-3 according to the following specifications 9� 1. Name of property owner Mar'/ Har^► 1ton) ��//T(, 3q$- 1170 Address to AMP l Co. Way SooTh Ai.m nv11, 2.Name of Architect(if any) Tel. 3. Name of builder Mike, Mc inS K�j/ Address ID HurJt uAtoN 404- 4. License No. Tela 9 So" Smo�Tt1.3 8 - 7L77 5. Name of Mason Address 6. License No. Tel. 7. Construction address 6, A mai ia. Way Sou ft yarwt.00il. Flood District 8. Date of subdivision Approval plain zone C- Zone it?- 51 0 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE 10. Multi family 0 /800.'0 2/? - et goof. Type of room No. Maidicf 11. Commercial 0 I•e Hoog-_ up routs- an _ 1/f�r To KitchePn t 12. Other 0 Mee& ua++.s-lb cob- Co WiningRm. 13. No. of stories `-,s` r--1) Living Rm.Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath 15. Materials — Wood 0 Cement 0 Other 0 Deck 16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 0 2 ❑ Family Rm. Sun room 18. Swimming pool - Size Garage 19. Storage shed — Size Shed 20. Stove — Wood 0 Coal 0 Alterations 21. Size of lot: No. of feet front No. of feet rear No. of feet deep 22. Size of building. No. of feet front No. of feet side No. of feet rear 2a Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from line or street From rear lot lin- Side line 25. H.I.C.R. No. 103tt6 / / LOT RELEASED BY Signature ��1// , //- PLANNING BOARD Addres / 7 p 14v►.k4 tot..- A✓,-- Date 5ov'iL Yat.matte Pkg. -. BUILDING DEPARTMENT . •. - • CONSTRUCTION SUPERVISOR FORM • • PLEASE PRINT: ' - • • , '' ) v • • • JOB LOCATION: (p . /1/3/4e.• I :C. £t&y SOU IQ.1" Ov NUMBER •! . STREET VILLAGE OWNER OF PROPERTY: M0.1r7 A&s%%At00 • CONSTRUCTION SUPERVISOR: Mckea IAL, C\u$keY jading39$- 7x.77 • • . •. LICENSE NO. • PHONE NO. ADDRESS: 7 D Nuw N, A✓c_. &utc Yar M60-tk - •• LICENSED DESIGNEE: (IF OTHER THAN SUPERVISOR) NAME • • • LICENSE NO. , 2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: • ;;; ii ri:0 HLp�E :11:: E LENT INC. • 0 Huntington Avenue 2.15.1 THE LICENSE HOLDER SHALL`BE FULLY•AND COMELETELY RESPONSIBLEE FORSi.b'- 'ORjC TORS WH/CH HE IS SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STAT 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, RE?AIR, REMOVAL OR DE`!OLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE CO:^!0:'WEALTH, 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 LICENSEE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE DISCOVERY OF ANY VIOL;TIONS WHICH ARE COVERED BY THE BUILDING PERMIT. 2. 15.4 ANY LICENSEE WHO SHALL WILLFULLY VIOL;TE• 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 RE,'OCATION OR SUSPENSION OF LICENSE BY THE BOARD. .15. ALL BUILDING PERMIT APPLICATIONS SHALL CONTAIN THE NAME. SIGNATURE AND LICENSE NUMBER 0: THE CONSTRUCTION SUPERVISOR WHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRLCT_C:r, RECON- STRUCTION. ALTERATION. REPAIR. REMOVAL OF DEMOLITION AS REGULATED BY SECTION 104.1.1 OF CC"•E AND THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSL IS NO LONGER SUPERVISI: SAID PERSONS. THE WORK SHALL IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SCBSTITUTE1 ON THE RECORDS OF THE 3UILDING DEPAR% NT. I HAVE READ AND UNDERSTAND HY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS .FOR LICENSING t STEUCTION SUPERVISORS I: ACCORDANCE •.riTH SECTION IO : 104.1.1 OF THE STATE 3UILDING CODE. I U: DE?S:TH- CONSTRUCTION INSPECTION CCESURES AND THE SPECIFIC-INSPECTIONCTION AS CALLED FOR BY THE •3UI_D'OFFICTAL. IHSUL.HCcCCVERACE: Ye: • - y insurance paicy ct : :ubst:n:iJ ec:rnient which meet: the carer. it you have ..._c:ced • ° 'ems' •eras et !.10L'�5,152 _• ;tease incc_,e the type .:•:era - snit: nate� •5- by C.`.eCXi.^,y^ :,`,_ --_.__aa:e ACX. A liability insurance =icy C:.`.er type ct 'aeemnry 0 done 0 • CiatE : :NSU :CZNAI' WAIVES: :h$:. Irl. :`- .:_^.-_ .C.. . ._ !n .._.- ce ec:e: ; recuec -- . Lir` . . ._ . .. _ •:-.•-t7.] ws. s -• cel g tat :z: :.' Suggested Affidavit for Home improvement Contractor Permit Application • • • Tee cake Us.Only. NAMECITY/TOWN • ' ' • Permit 2do, . Whinn✓ . Date ' - . •• • . ... I 8: AFFIDAVIT ' Home Improvement Contractor Law • • . Supplement to Permit Application t • MoLe.i42Arequires that the"reconstrue!Ion.attention.renovation,repair,modernization,conversion,inprovemenl.removal-demolitions oreonstruction or an addition to anv pre•edstine owner•oceunied building containint;m feast one but not more than fourdweiline units....or • •to structures which are adjacent to such residence at huildine"be done by registered contactors,with certain aceptions,along other_•. ' requirements. - . Type of Work: (� at np 1`P ho0 3 93 d- eves.- 1�Est. Cost'IeDO • .Address of Work to A M e L&. h.y.• rs04 YQ��D✓Tf. •• . Owner Name:' Merry, Y�4»�i b u • ' Date of Permit Application: SP SP e+. at/ 9 9 3 . • • • 'Thereby certify that: 1 Registration is not required for the following reason(s): •t• ' Work excluded by law -• 1 _Job •under$1,000 • • _Building not owncr•occupicd . ' ' _Owner pulling own permit , ' ' Other (specify) ,. . . ' Notice ii hereby given that: • -� - clOWNERS PUIrLING THEIR OWN.PERMTI. OR DEALING WITH UNREGISTERED' t • CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE . •r' • ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MOL- • c. 14.2A. • .Signed under penalties of perjury: • I hereby apply for a permit as the agent of the owner: • 9-019- 93 Alike Ale Cf✓sl key Date Contractor Name ��/r°�6 Registration No. OR: , Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: • D�Cc� Owner Name •'• ' TWJLCD 1911£ IM/k4VESEM ft,;:. rn ttprotE IMP OVEMENT INC. 10 Huntington Avenue Os. tdh%K)i tb, W1 01S4 (CV)LiL.3' Tf1 ,I'r1f. 1. ,4r(k cr;. (fin/i; .'.�> =9 1'7 I ` —_=� x COMMONWEALTH OF MASSACHUSETTS �. - c/�e DEPARTMENT OF INDUSTRIAL ACCIDENTS ` '�r 600 WASHINGTON STREET James Camopeu BOSTON, MASSACHUSETTS 02111 . Gomnss over WORKERS' COMPENSATION INSURANCE AFFIDAVIT • NtL MC. aSLR y (li ce nsee/permi stee) • with a principal place of business/residence an 71) avt.Etwg1-ow ,��- cS',4„ y & 4 o2 n0,# /1T CC 6CY (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. Insurance Company Policy Number [] I am a sole propricror and have no one working for me. [] I am a sole proprietor, general contractor or homeowner (cirde 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 - Q I am a homeowner performing all the work myself. -- -- m NOTE_ 'lease be aware that while homeowners who emnloy persons to do maintenance,construction or repair work on a dweliing 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 Insurantz for mvenge verification and that failure to iecure coverage as required under Seton 25A'of MGL 152 can lead to the impoiition of criminal penalties consisnng of a fine of up to 51500.00 and/or imprisonment of up w one year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day against me. Sign ' • is ...0 n• day of cS-4. If , 1993 .. / e _. .se::Per...,.._ /'P- Lice o::Permiror