HomeMy WebLinkAboutBLD-93-749 oi Yqk alb /b/V/P
,. o TOWN OF YARMOUTH
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%,'tZ'D f Application for a Permit to Build No. 71/9
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UPON ANAL APPROVALMAP PS LOT ñ
FEE MUST ACCOMPANY THIS APPLICATION. DATE /0/i X93 19
The undersigned hereby applies for a permit to build /0/41/9-1
according to the following specifications21/471/Gl...3
Name of property owner/VS/ S> gar/ Tel./776-'5-6-36 _
Address /645 A2''1I/6r' dcwg._,2ux1c- A'4. 0263? _
2.N me ofArchitect(ifany) Tel. ,._
L3. Nameofbuilder LAW S4- 'e dn- /0 " _Address 4OileSr' �r",v��da/!lt ,'-iA-
icense No. 0O,25"9g Tel.6109 4ZF3 -8s'S2. 64263a.
5. Name of Mason Address — _
6. Li nse No. -- Tel.Li-Construction address 34. /et B-.F.-, IL,0 yf
Flood District B
8. Date of subdivision Approval plain zone C- Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE -
10. Multi family 0 L_41"--75i000 S ''� JOE Type'of room No.
rz
11. Commercial7z, Ceize Kitche
12. Other ❑ -570 D Dining Rm.
13. No. of stories 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 ❑ Other 0 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 ❑ 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. � ��L r. L���
LOT RELEASED BY tgnature '
PLANNING BOARD Address- Doe .S/r2�Z-r—
Date 4-,vg=ru '/ag /n', . 0:0e32
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--• -- TOWN OF YARMOUTH
• BUILDING DEPART:ENT .
CONSTRUCTION SUPERVISOR FORM
• PLEASE PRINT: - ' •
/x1643 ,
• GJbB L CATION: 8/6 . fr/p/N Jar �•28 ) - a). VM''oar71
NUMBER . STREET VILLAGE
.
OWNER OF PROPERTY: - ...4,4-../..4/ (5.-12 4 .429/ we e G24:2:%✓- T2i2S/L-G-
(20NSTRUCTION SUPERVISOR: All:G T 4.6---'36-4. ' • • . Ma-5'Fo 3215128-ST,(2..
... NAME //�J . •. LICENSE NO. PHONE NO. . • .
• ADDRESS: 4 Mk' 6",/,22-z:-/- CLL-1/TLJ'�!l/LLL= /t/P- C",..W 3Z
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 .
• i TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD.
• . 2.16. ALL BUILDING PER.`SIT 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 LICE.`ISE HOLDER IS SUBSTITUTED
• ' ON THE RECORDS OF THE BUILDING DEPARTMENT. ' ' ' - .
' I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ‘FORLICENSING CC:1-
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTA:::
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
OFFICIAL. ;
INSURANCE COVERAGE: • .. -. .. .
have a current liability insurance policy or its substantial equivalent which meets the requirements of MGLth.152 �",:- .
Yes Q'. : :: No ❑ . :: . ,,.. . .
If you have checked Nes, please indicate the type c average by checking the apar cpriate bar:.
A liability insurance pc:icy E r Other type of indemnity 0 -• - Send ❑ - -1--- -
OWNER'S INSURANCE WAIVER:I am aware that the f:censee deet net have the insurance ccverge required`
•Chapter 152 of the Mass: General taws, aria that my signature on tn:s permit a:paction waives this requirement -
• Check one: •
• Owners Agent❑
.gaawre of C`.ner cr Owner ss gent •
IGNATURE: /1.. '7 -7e-^-7 BUILDING OFFICIAL APPROVAL: