HomeMy WebLinkAboutBLD-93-751 OF•Y'9R o lC Pry
'f = o TOWN OF YARMOUTH
41
�"t�,ro..,,o.�""`""'�,%6Application for a Permit to Build No. 7\51
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UPON FINAL APPROVAL eel; Si / 9i MAP I3 LOT 1-1 3
FEE MUST ACCOMPANY THIS APPLICATION. DATE / -•� 19
The undersigned hereby applies for a permit to build /z7��—/9 3
acibrding to the following specifications / /����
1. Name of property owner 41-24_9 LJ_ �/twit) Tele//-77�g3
VAddress ► [o (if rirnexAA4 c'r1n9
3.Name of Architect(if any 12yt0lc V Tel.'?
. Name of builder S L ID Y1 &fl1ra> Address . d,
4. License No. Tel.
1 . s
5. Name of Mason Address
6. License No. el.
f .. r frr t �.r .� _ „ fj ati2i lin /9- a?G73
7. Construction address _______--___ WS.e#f....rs,-_,tts-.&a
ood •istrict2 15�
8. Date of subdivision Approval plain zone 1� Zone
9. Private dwelling 0 / Estimated Cost DO NOT WRITE IN THIS SPACE
10. Multi family 0 o7 f OO Type of room No.
11. Commercial ❑ riv_ - Kitchen
12. Other ❑ Dining Rm.
13. No. of storiesC Living Rm.
Bed Am.
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 0 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 0 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
2a 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 �Sig�na�t e C,l (I)plinatjj
PLANNING BOARD t4ddressO 1 (pc,l'1 0 n4a, ot�.tinQ,
Date c% ?oAn wi wv , YY1/9- -
JD1
/119' 3,,e3-722-L„Da 7�3
Suggested Affidavit for Home Improvement Contractor Permit Application . ,
For Office Use only AME OF cnyffr it
Dalt
Permit No.
/ 721
•
_ AFFIDAVIT
Home Improvement Contractor Law - -
Supplement to Permit Application
MGL e.142A requires that the"reconstruction.alteration,renovation.reoair,modernization.conversion.inprovement.removal.demolition.
orconstruction of an addition to any pre-ccisting owner-occupied hwldinz containingat least one but not more than fourdwellin?units....or
to structures which are adjacent to such residence or hmldinz"be done by registered contractors,with certain aceptions,along with other
• requirements. •
Ty ��pe of Work: c ao Est. Cost o2//06
• Address of Work /6•_,(2,17)27/7.444, J
Owner Name: �Zc�(/
Date of Permit Application: 00
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law
_Job under SI,000
Building not owner-occupied
ZOwner 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. I42A.
Siened under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR: •
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: !,
JO-Q -9 3 (10,1,-td 9d "46
Date Owner N me
TOWN OF YARMOUTH
•
` BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE 1b -cf -93
JOB LOCATION C _ r di a I _ , 1 $&, _ II 4
NUMBER STREET ADDRE S /ACTION OF TOWN
"HOMEOWNER" ,td eQa I u ) n) �7 f —�7( 3
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS J6e_a_i ° °IC_rs4) L ft
( ,t ) C�a inn rt M r 6 rc(07,�
Y OR TOWNSTATE 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
ATTACH E D 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 COMPLY WITH SAID PROCEDURES AND REQUIREMENTS.
•
HOMEOWNER'S SIGNATURE ,L0,( p -.L() 9 xF�L7
APPROVAL OF BUILDING OFFICIYiL vv
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes r2No ❑
If you have checkedym, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy 17eIOther type of Indemnity 0 Bond 0
OWNER'S INSURANCE•WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
I /�� Check one:
a(4p �, LON Owner Agent 0
Si nature or Oler or Owner s Aaent