HomeMy WebLinkAboutBLD-93-748 stern
` Vr; 4 o TOWN OF YARMOUTH °`
MATTACM[ s �f u
�.....,�• 6% Application for a Permit to Build No. i I
UPON FINAL APPROVAL r� l° .....q 1/-43
MAP i L /(/ 7 z
FEE MUST ACCOMPANY THIS APPLICATION. DATE
The undersigned hereby applies for a permit to build /6/#9:3
according to the following specifications �o//x/93
1. Name of property owner r <-1-1 } ays r .
Tel. 775-13207
Address /4 fy�iufv ... got • •f
2.Name ofArchitect(ifany) / Tel.
a Name of builder LL. . (A-'k//S Address'7R 64e4-tr)x A-c.e S Yale'
4. License No. n 045 Tel. X41 g-/2-05-
5.
-/Zcc5. Name of Mason Address
6. License No. Tel. nn
7. Construction address / 4/gam tf0 d w y '
Flood District
8. Date of subdivision Approval plain zone Zone R cost{
9. Private dwelling g Estimated Cost DO NOT WRITE IN THIS SPACE
Type of room No.
10. Multi family 0 6 00 0 s%79PR5
lo�Dowc,��z►L
11. Commercial 0 Nati �Kr VPnot•ocE Ma 6nsr GJitook w41R Kitchen
12. Other ❑ Ser E vs7ni2s` � ��� Dining Rm.
13. No. of stories ;"2""``7 ' if Living Rm.
t/< Bed Rm. S
14. Foundation — Full pi Half 0 Crawl 0 Slab 0 1374 .41€4..� a �.�rS_
15. Materials — Wood 0 Cement 0 Other 0 . -.5-li i-2-lec (ssn) Deck Adeate sir
16.Type of heat — Oil 0 Gas 0 Electric 0 Other ❑ Closed porch
17. Garage — 1 0 2 ❑ I ar -j`-a� Family Rm.
18. Swimmingpool - Size W'fy0 W um-IR 331 a° Sun room
Peek FiRsrat,a �s asa Garage
19. Storage shed — Size '- jar,p O fl1A% I
20. Stove — Wood 0 Coal 0 No 1'. k /O`"� ; Alterations
,v v
21. Size of lot: No. of feet front ito 0. of feet rear / v No. of feet deep
22. Size of building. No. of feet front 3 0 No. of feet side Z Q. No. of feet rear -5613
2a Distance from nearest building: Front /2o ' Ft. side /5 ' ' Ft. side Rear Coo a 1;
24. Distance back from line or street 30 From rear lot line /8 Side line /01
25. H.I.C.R. No. .' /GC/ 7 9
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LOT RELEASED BY Signatu . /
PLANNING BOARD Address 7r/ �i� Ac-e
Date S 7a r 04ot.A
- T___e, BUILDING-:-PERMIT APPLICATION SIGN OFF -`
•
Ar LICANT: A-U 5 . . BUILDING PERMIT 1/:
ADDRESS: 73 s 4-a4tOY\'/' - - TELE. NO. : 3Q4 /ZG}DATE FILED:
BLDG. SITE LOCATION: 1 4 (c (j%6 ) , . MAPA: 1 (eD LOT//: 7-z_
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. c '
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 DEPARTMENT0 ,/ DATE: !/27/Q3 N/A:
I 'UST: 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
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BL.M/89 411111 •
•
,. Suggested Affidavit for Home Improvement Contractor Permit Application
For Omce Use only I „NAME OF CITY/TO WN
Permit No. x�7 LAV'/uF �-(t
Dao 6,.
AFFIDAVIT
Home Improvement Contractor Law
• Supplement to Permit Application
MGL e.142A requires that the"reconstruction.alteration.renovation.re:xais moderniration.conversion.inprovement,removal.demolition. -
orconstruction of an addition to any pre-costing owner-cccunied 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: VCnp 2. nQ�� Est. Cost(„/U0 O- --
Address of Work ( '4 1 j(114.c1 U ,yk
Owner Name: POW at tre) Lt, I L .moo. -"C_,t✓
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law
_Job under 51,000
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 PROGRA.M OR GUARANTY FUND UNDER MGL "e
c. 142A.
Signed under penalties of perjury:
I hereby app v for a permit as the agent of the owner: '
DZe
Cdntractor Name Registration No.
OR: ' •
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
Date Owner Name
• BUILDING DEPARTMENT
.CONSTRUCTION SUPERVISOR FORM -
LEASE PRINT: • '
OB LOCATION: A g. I `..,-__.-___.- - ` rwet./ ala
UMBER a . STREET VILLAGE
WNER OF .PROPERTY: ' b4rn.VeK)
•
•
ONSTRUCTION SUPERVISOR: T--(20 ...^i 115 0Q -1 zo
NAME r •i LICENSE NO. PHONE NO.
•
)DRESS: 78- ��l � tl✓L /{ li`-Q— S�4k (ofirtelL 4"1 •
•
ICENSED 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 CO1TLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE
IS SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE
-UILDING• 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
"0`24.ONWEALTH, EVEN THOUGH HE, THE LICENSE• HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB-
"ONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER.
2.15.3 THE LICENSE HOLDER SHALL IMUIEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE
ISCOVERY 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
THER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL 3E SUBJECT
0 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 TS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECON-
STRUCTION, ALTERATION, REPAIR, REMOVAL OF DDOLITION AS REGULATED BY SECTION 109.12_ 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:LENT.
I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS .FOR LICENSING Ci::
STRUC-ION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERST:::
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDIN
OFFICIAL.
INSURANCE CCVERAGE: •
I have a cerrert I}'a-- ity insurance policy er te subs:anti) equivalent which meets the requirements cf !SRU th.152
Yes ceNo ❑
f ycu have checked_ please ircicte the type c;•:erage by checking the a_c.:ciate box.
A liability insurance pc:icycrC Cher type cf '.icemnity 0 Bund 0
CWHER•.. ;NSURANCE WAIVES: I am awarle that the ccensee dc_- ". %.,'ct ti^ ,' the inaumr.ze ccverge rec.::rec
Chat: f the Liz. Iris. a :hat my sig _:ure en perm:: __:::ca.en waves the rectuirer- .
Checx ere: •
ai C'.�r.e ❑ As. ' 0
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(S.,r.a:uo r C..n. r U.. nc
igp
.._ ... .
to - COMMONWEALTH OF MASSACHUSETTS . - _ - - . . _ ..- _
• " r DEPARTMEIcT OF INDUSTRIAL ACCIDENTS
%'4 600 WASHINGTON STREET •
James a voet; BOSTON, MASSACHUSETTS 02111 •
Corn ssoner WORKERS' COMPENSATION INSURANCE AFFIDAVIT •
q camelk
(licenseelpermitte ) •
• with a principal place of business/residence at:
�` IA �{ /� .
(F S d-A-- 1) rP �YJI)'C�L Ce Y t/Y`P1tJ 1 ul( /l
(CitylSute p)
o hereby terrify, under the pains and penalties of perjury, that: -
[) 1 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.
( m a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below
who have the foil wing workers' compensation insurance policies: ••- •_ •
r A
E'4 ei cc rig a-5
Name of ContractorInsurance Company/Policy Number .
I\A. k((-.Q Pvteitt ( C 8 pn F o( - O q
Name of Contractor Insurance Company/Policy Number ..• -
Name of Contractor Insurance Company/Policy Number ,
0 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
dweiiing of not more than three unto in which the homeowner also resides or on the grounds appurtenant thereto are not generally
considered to be employers under the Woriten• 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 Ix forwarded to the Department of Industrial Acddena' Office of Insurance for coverage
verification and that failure to secure coverage as recuired under Secion '_5A'of MM. 152 can lead to tie imposition of criminal penalties
consisnng of a fine of up to S1500.00 and/or imprisonment of up to one year and div penalties in the form of a Stop Work Order and a
fine of S100.00 a day again::me.
Signed this a (0 day of /40?Qs , 19 ( 3
.l 4/1
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TOP OF FOUNDATION IS C•r FEET .�1 ? • '
ABOVE HIGH POINT OF ADJACENT `l' ,=c� ' VATIN 0ti?}i1„ `,JAS$+,;;
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- <ELDREDGE ENGINEERING CD.,INC) r ` Aterc. I CERTIFY THAT TFIEFo'v+s/p.Eli4;,;;O;,
CLIENT SHOWN ON THIS PLAN IS 'LOCATED
JREGISTERED'1 REGISTERED`• JOB N0.2 0 / / ?_ ON THE GROUND AS iNDlCATED'.,t AFD,
- • , CIVIL LAND CONFORMS TO THE ZONING • CAW$.I
ENGINEERS . SURVEYORS r DR, BY: 4 • A. '7• OF YARMOUTH , MASS. �c r r.dx9
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CIVIL LAND JOB NO.r82l�fb ON THE GROUND AS INDICATED AND
ENGINEERS SURVEYORS DR. By, mows CONFORMS TO THE ZONING LAWS
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