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Home My WebLink AboutBLD-93-747 FYq r o it, to- .vo TOWN OF YARMOUTH ��l 0 44` MATTACCIS 4.1e6z*. ..M,.J.,/ Application for a Permit to Build No. /VP/ UPON FINAL APPROVAL MAP .2 LOT i 57 FEE MUST ACCOMPANY THIS APPLICATION. DATE /P// 19 73 The undersigned hereby applies for a permit to build /o/'//q3 according to the following specifications SVOC) \1. Name of property owner XII-016-5 S�� % r1/ Tel. 3CS' \Address _ 77 NeSH (e/7- C�snt / /L!/9- 0/ y.S.-" 2.Name of Architect(if any) Pc/ 9- Tel. 3. Name of builder 7%0 JAI i?c/Nt-7? Address 4. License No. Tel. 5. Name of Mason Address 6. License No. Tel. N 7. Construction address 63- QS' a) = Yn2sr°unf fil 4- Flood . District 8. Date of subdivision Approval plain zone ei Zone 2 1-� 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE Type of room No. 10. Multi family 0 \ 25-o 04°11. Commercial 0 oi i7, Kitchen ere 12. Other 0 4 �,0, ' Dining Rm. 13. No. of stories lip i- Living Rm. Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab ❑ 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 X ai D08LeFEE Shed g tg' / 20. Stove — Wood 0 Coal 0 - vox iiimaor Pwi7 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 \ Signature I 0 CE---_, PLANNING BOARD \Address 3t7/t099-14(42- 429 Date 6f0774AJ 141 .cY/V€ /oh 1"3 r v BUILDING PERMIT APPLICATION SIGN OFF APPLICANT! (77htn _ g/ / y7,, BUILDING PERMIT Il: ADDRESS: 77 /ViI)/f�/T P 'ELE... NO. :. DATE FILED: /0/4 `BLDG. SITE LOCATION: 335 )/ //27W ,i w /'�vey LOTH: 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 DEPARTMENT: DATE: N/A: • 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 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. COMMENTS: • ELM/89 !d/j/93 F.-27 • 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 MGLa 142A requires that t he"reconst ruction,alteration.renovation.repair,modemiiation.conversion,inprovement,removal,demolition. orconstruction of an addition to any pre-existing owner-occupied 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 eruptions,along with other requirements. \Type of Work: stitel2p, Est. Cost /� Address of Work 5-3—/tat oS' e0 (,(). j/,*CM s(7y / 4 ✓1 \ Owner Name: tJ JES /SE/jCC?///Mt Date of Permit Application: /O/!/J 3 \I hereby certify that: r Registration is not required for the following reason(s): _Work excluded by law _Job under S1,000 Building not owncr-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: Date Contractor Name Registration No. OR: Notwithst ndin the above noti I hereby apply for . permit as the owner of the above property: fe I 3 ,,. / \pate 0 'ncr Name / • COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF INDUSTRIAL ACCIDENTS ' 600 WASHINGTON STREET • James J Campoeu BOSTON, MASSACHUSETTS 02111 Comn ssroner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • (licensee/permittee) with a principal place of business/residence at 77 al/#u4- 1e0 c fed ZVA/ P74- (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 proprietor and have no one working for me. ( ) 1 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 . _ `.(I am a homeowner performing all the work myself. •• - - NOTE_Pleue be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dweliint 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 Insurande for coverage verification and that failure to sccure coverage as required under Section 25A'of MGL 152 can lead to the impoiition 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 5100.00 a day against me. Signed this 1'S�' day of 00T , 19 23 1 \.i•-.. „rPe...., .:t / LicensoriPermittcr TOWN OF YARMOUTH • BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION • PLEASE PRINT: NATE 4/9/ nn JOB LOCATION 53 Mac �'�• (U. y4V,T/�7 /1113- NUMBER STREET ADDRESS//�� / ��/77 SECTION OF TOWN \"HOMEOWNER" v'�149z5 L ;,gyt/ .704/ //�,6 // /79V7 7710 NAME ��// HOME PHONE WORK PHONE /t' PRESENT MAILING ADDRESS 77 0/9- 40 . • C- o7M /h/9- of Ys O 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 WILL C PLY ,WWITpH� /1 ' PROCEDURES AND REQUIREMENTS. N- HOMEOWNER'S SIGNATURE a/n/. y� 6 /1 e APPROVAL OF BUILDING OFFICI • \ INSURANCE COVERAGE: I have a current liab4ity Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes & No ❑ If you have checkedrimes, please indicate the type coverage by checking the appropriate box. • A liability Insurance policy Other type of Indemnity ❑ Bond 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Ma . General Laws, and that my signature on this permit application waives this requirement. Check one: • F ,�— Owner 0 Agent ❑ Signature f er or e• n•r "Acent LI .. PLOT P • LAN FOR LOT # • Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) E Well r I (lot ft. rear) — — — — 0 Abuttor's t �� Abut Name - J Name •Lot # I • Lot # REAR YARD If this is a Com. If tl corner lot, i ft. come write in name I writ of street. name i a, othe A00 stree • • SIDE YARD SIDE YARD • HOUSE 0 FT. 0 • 0 FT0 • v '` 4 , • SET BACK • • I ft' I I 12205 g i • (lot ft. frontage) - .. \ / 5s Amos 40 , \ / \ / (NAME OF STREET) / �\ \ -Information �U / \ Supplied by Oti BUILDING ':*.41 • - % TOWN OF YARMOUTH ELECTRICAL CF GAS 0 .�ti's,a �,;. M3+ 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664 M�rrnc, noun, is �,' Telephone (508) 398-2231 PLUMBING SIGNS BUILDING DEPARTMENT September 24 , 1994 James H. Seferian 77 Nashua Road MAP 26 LOT J-51 Groton, MA 01845 Subject: Notice of State and Town Violations As owner of 55 Amos Road, West Yarmouth, MA you are hereby notified to remedy the conditions named below within 7 days of the service of this notice, Sundays and legal Holidays excepted, or show cause why you should not be required to do so: Violation CMR 780 MA STATE Building Code Chapter 113 .0 Construction without a building permit Violation Code of the Town of Yarmouth Section 103 . 1.1 Construction without proper permits (Construction -of -a -shed) If at the expiration of time allowed these conditions have not been remedied and no cause aforesaid be shown, such further action will be taken, as the law requires. Any objection or inquiry in reference to this notice should be filed before the expiration of time allowed for abatement of the nuisance. BY ORDER OF THE BUILDING COMMISSIONER Inspector William Stone 2005 c.!/ Address all communications: Town of Yarmouth Building Department 1146 Route 28 South Yarmouth, MA. 02664 WS:des CERTIFIED MAIL: P 372 125 764