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Home My WebLink AboutBLD-93-735 P�nP iWo,1 li l a `j�2 3 .6i3/411. ! 'r .,,�'o TOWN OF YARMOUTH o Ftw /A7/93 t M TTAEME 5 �i V4a ..o.5' , Application for a Permit to Build No. 7,35 UPON FINAL APPROVAL ?'30 93 MAP . 445 L 4 ? FEE MUST ACCOMPANY THIS APPLICATION. DATE '7/7 19 99 The undersigned hereby applies for a permit to build '9 gat according to the following specifications 7303 1. Name of property owner 'frail G4 --4412/00-61 nea, Tel. Address 1190 gt. 74- `Wiwi-hi 2.Name ofArchitect(ifany) U'Yffff,4 c JkU420 Tel. Z37-re 3. Name of builder ing9Te2 &Pr,' • s� Address 1STw Sri gfetsiki9ezaili 4. License No. Oqt 32s- Tel. 617-s7' f05p55 5. Name of Mason ;To/A4 F ,Lc27d address ft. 139 4a-et Al 6. License No. ,778`1 I Tel. 8 ate..3(// ! 7. Construction address O44- fff&T!,laf Ctioleata led.. tOt Flood District R._em 8. Date of subdivision Approval plain zone G Zone 9. Private dwelling ❑ Estimated Cost DO NOT WRITE IN THIS SPACE 10. Multi family 0 0 ` '. CO�G12oSia� Con r£ Type of room 1 No. 6'a6„. Srrf #;v l tirc. AcPC- 11. Commercial 0 i p14/Gy or- Kitchen 12. Other W ereze St/ y] Dining Rm. 13. No. of stories t -• �, Living Rm. `f� !O Bed Rm. 14. Foundation — Full Ia ttalf 0 Crawl d Slab�E ,1 Bath 15. Materials — Wood 2Cement 2eOther 0 Deck 16.Type of heat — Oil 0 Gas O'Electric 0 Other 0 !/G Closed porch 17. Garage — 1 0 2 0 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 5'4 ThNo. 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.O E. No. P� �, LOT RELEASED BY Signature �'� PLANNING BOARD Add ss Fre- P&4/p' Sr Date - /".5- itete /111 BUILDING PERMIT APPLICATION SIGN OFF APpLICAIIT: Clparwatar ResousLPs BUILDING PERMIT II: ADDRESS: 858 Plain St Marshfield , MA " 61. -TELE. NO. : ' 7_8 'r-O 8 DATE FILED: • BLDG. SITE LOCATION: off Higgins Crnwell Rd MAP#: An LOTI!: 0.2 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 REQUI' LI'NTS 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: \ \-1-1C11 J N/A: 2. ENGINEERING DEPARTME. : DATE: N/A: 3. CONSERVATION: /� �_2 DATE: 47.-j-7— p3 N/A: 4. HEALTH DEPARTMENT t7/�� ii��Rs -= DATE: �/)?I93 N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: �� } `DATE: SEP 2 7 1993 N/A: 6. PLUMBING INSPECTOR•/� ; it,t-,_'/f 7o ,� ,Z/ ?/ DATE: Z-o?J-95 N/A: 7. FIRE DEPARTMENT: ,' 64141-�( 201L- DATE: i. 'i . ')3 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. I COMMENTS: IRU - VflSIS S�wi1 ' min c-A1-5},Aak -"a Pi\at, (ham, u BLM/89 TOWN OF YARMOUTH • • BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM ' PLEASE PRINT: ' • • JOB LOCATION: off . Higgins Crowell Rd . NUMBER . . STREET VILLAGE • • Town of Yarmouth. OWNER OF PROPERTY: • CONSTRUCTION SUPERVISOR: . John P. Ryan 042325 : '617-834-0585 ' NAME . . . LICENSE NO. PHONE NO. . ADDRESS: • • 858 Plain' St , Marshfield , .MA :02050 • 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 ELEIENTS OF BUILDING AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE • COMMONWEALTH, 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 DEPARTMENT. ' ' ' . . .. ' " • • I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR LICENSING CC'I- 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 cunen liabilityinsurance pclicy or its substantial equivalent which mees the requirements of MGL1Lh.152 Yes ` . .:._ No ❑ ;_:'. _: _ _ If you have checked v_s, please in•dicate the type c average by checking the app:cpriate bex ` :'.':'._' '.`; • :1.:K:_ —: A Liability insurance pcticy 0 Other type of ademnity❑ • - Bond 0 • -- OWNER'S INSURANC'c WAIVER•I am aware that the r:censee deet re+ have the Insurance coverage requiree b;� Chapter 152 of the Mass: GenerJ L^ws, ana that my signature en rs permit ::plic:ticn waives this requirement . • Check one: • OwnerQ Agent 0 Signature of Owner cr Owners Agent • n • SIGNATURE: •�y. BUILDING OFFICIAL APPROVAL: s • fi s-• c COMMONWEALTH OF MASSACHUSETTS Fk DEPARTMENT OF INDUSTRIAL ACCIDENTS NkCi' 600 WASHINGTON STREET • p: _ • BOSTON, MASSACHUSETTS 02111 • , ames CampoeL • comm:ss:oner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • ], Clenrwater Resnurres Int_ (licensee/permittee) • with a principal place of business/residence at. . 858 Plain St. Marshfield, MA 02050 • (Ciry/Sate/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. • ITT Hartford CU 5775 Insurance Company Policy Number (J I am a sole proprietor and have no one working for me. [J 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 0 I am a homeowner performing all the work myself. NOTL.Pleue 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 for a license or permit may evidence the legal suites 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'of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to S1500.00 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. r ,p (� Si ed this 023 Rd day of Snail— , 19 RB keairrtik tr.r.seelPe..^.,tc._• 6 Lic.asor/Permiror