The URL can be used to link to this page

Home My WebLink AboutBLD-93-736 P��P S7 r Z� � . 1=..; .oF.YgR ., Oe 9 �7 / s�, , tsa TOWN OF YARMOUTH - 919/93 MATTA [� 1'II Valk...70i Application for a Permit to Build No. 736 UPON FINAL APPROVAL 9`30 93 MAP !o V LOT 4/ FEE MUST ACCOMPANY THIS APPLICATION. DATE The undersigned hereby applies for a permit to build I/3d/9� according to the following specifications 773d/93 1. Name of property owner TOw/F 04 \h-maeris P.P. W Tel. Address //y6 ft y? `Otifoc 'M` fi 2.Name of Architect(if any) L #I713$iCP * ifra41D - A1C Tel. 237f er 3. Name of builder 12 V49JJ4t_ ke,AX/lcer L,iLS_4ddress 71? P'-tee f7'Mv-Mev A 4. License No. on 5 2-C Tel. 6/7 7341 '571'- 5. 5715. Name of Mason CIS F. k'etter' Address406/2 c�c' 13P N'fz'a e2 11,- 6. License No. 737 F'i/ Tel. I Z-(O'3Q71 7. Construction address 044 )11/61.11/4" Ceoefreeo at Flood District 4 il 0 8 .Date of subdivision Approval plain zone Zone 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE �� C'o,G2oSioiy Tt Type of room No. 10. Multi family 0 r, _,�; 7 $LDG-- 5 # 3o ehrL Roc- / 11. Commercial 0 w /71/60 or- Kitchen 12. Other 8^Vitt WDining Rm. 13. No. of stories 1 - Living Rm. Bed Rm. 14. Foundation — Full C'HaIf 0 Crawl D Slab_CI` Bath , 15. Materials — Wood El–Cement El' Other 0 Deck 16.Type of heat — Oil 0 Gas ErElectric 0 Other 0 Nlri Closed porch 17. Garage — 1 ❑ 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 Sce- NWNo. 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 PLANNING BOARD Add ess fly a Date f' n,c X 1 it/1 AM CW5-0 BUILDING PERMIT APPLICATION SIGN OFF'• •APPLICANT: Clearwater Resources Inc BUILDING PERMIT ll: ADDRESS: 858 Plain St. Marshfield, MA TELE. NO. : ' 617-834-0585 DATE FILED: BLDG. SITE LOCATION: off Higgins Crowell Rd . MAP//: 64 LOT#: Al 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 TTIE REQUIRED BUILDING PERMST: REVIEWED BY: 1. WATER DEPARTMENT 40 • DATE: cs \..C1\5)13 N/A: 2. ENGINEERING DEPARTME DATE: N/A: 3. CONSERVATION: awl_ ' DATE: tre —7J N/A: 4. HEALTH DEPARTMENT `$' �. �� s ' DATE: f a-5_/ N/A: INDUSTRIAL AND/0' COMMERCIAL PERMITS 5. WIRING INSPECTOR: / /// DATE:4EP 2 7 1993 N/A: 6. PLUMBING INSPECTO • /x ��j%l TE: —0`?7_Q 3 N/A: 7. FIRE DEPARTMENT: L ' DATE: j?,S 6'j 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: 'Ien k. 5141,N, aP kr) f _ .'F. • BLM/89 {,_�:Jas. _- COMMONWEALTH OF MASSACHUSETTS -E�� DEFAR:'MENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET amen J.Cannon BOSTON, MASSACHUSETTS 02111 • ommassoner WORKERS' COMPENSATION INSURANCE AFFIDAVIT I, 1 arwater Resnsirraa Tnr (Ii ce n see/permittee) • with a principal place of business/residence at.. 858 Plain St . Marshfield , MA 02050 (City/State/Zip) do hereby certify, under the pains and penalties of perjury, that: X 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 O I am a sole proprietor and have no one working for me. ' [) I 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 D I 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 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 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 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 (/'rCied-- /`7p day of V[ , I9 29 / .1 ficer:sc_iPerrn ?c. Licensor/Permi-or ' TOWN OF YARMOUTH " _ n► • BUILDING DEPARTMENT • . CONSTRUCTION SUPERVISOR FORM . • ' PLEASE PRINT: ' • . • • JOB LOCATION: Off HIQQinS Crowell Rd, . NUMBER . STREET . . VILLAGE OWNER OF PROPERTY: ' Town' of Yarmouth 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 ELEMENTS 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 BE 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 IiEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ' ON THE RECORDS OF THE BUILDING DEPARDENT. ' • . . ' I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR .ICENSING CC:1- 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: • - . ... 1 have a curie liability insurance pclicyor its substantial equivalent which meets the requirements of MGLth.152 :Yes . ,' •sNo0 If you have ecked v s, please indicate the t•;pe c average by checking the appy cpriate tick.. "_':`':•'i` • "' A liability insurance pc:icy 0 Cher type of :.idemnity 0 Bond 0 • - -• 1 OWNER'S INSURANCE WAIVER:I am aware that the ccensee does rat have the insurance coverage requires Si Chapter 152 of the Mass. General Laws. ane that my signature on th:s permit ccplicaticn wanes this requireMent • . • Check one: S: Owner° Agent 0 ' Signature of Owner cr Owners Agent • AO :J , SIGNATU • �y .•/�/.� n," . BUILDING OFFICIAL' APPROVAL: i