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Home My WebLink AboutBLD-93-752 r .,ieTr ,,� o. TOWN OF YARMOUTH o r �4 �MAT•TA .,,:s 4 r ..�„o. -- Application for a Permit to Build No. 74 UPON FINAL APPROVAL (91- PO /0 MAP /r LOT CS- / ' 9 FEE MUST ACCOMPANY THIS APPLICATION. DATE ns 4- 4 19 — The undersigned hereby applies for a permit build �� /0/ 14-173 according to the following specifications ( !� P 10 Ve75792 1. Name of property owner V . l/, G . H .�� 'd Sast.S..e Tel. ';94-x-53,3 Address t-). s c . S1.:or0 b,r . 2.Name of Architect(if any) Tel. 3. Name of builder f r<� I te.c rt i I Address i_ s k +--Lna41-- rt . 4. License No. Tel. 3 s-5 - S ro I 5. Name of Mason Address I i / 6. License No. Tel. 3 4/ Y-3 7. Construction address 13 S' c s L (,t J Flood District 8. Date of subdivision Approval plain zone Zone IC-.1- 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE Type of room No. 10. Multi family 0 4 300 . 00 5fr) 6c.- Gn5 11. Commercial 1 4.. go-r tatrEA ffntrER Kitchen 12. Other ❑ , o, , Dining Rm. 4, 13. No. of stories io, Living Rm. Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath _ 15. Materials — Wood 0 Cement 0 Other ❑ s,�<b 51/81-1 Deck 16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 0 2 ❑ -012 Arisith Family Rm. Sun room 18. Swimming pool - Size j t-/RC COD4- Garage 19. Storage shed — Size Eri72iO4 Shed ' Cgs I Nip 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 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 `l3.cu.1/44� PLANNING BOARD Address Date COMMONWEALTH OF MASSACHUSETTS P' E DEPARTMENT OF INDUSTRIAL ACCIDENTS '' 600 WASHINGTON STREET JamesCamooei, BOSTON, MASSACHUSETTS 02111 ' • Cpmm:ssonef WORKERS' COMPENSATION INSURANCE AFFIDAVIT _ • __ • _ I, I3 cif t, I • (licensee/perminee) •Ci • with a principal place of business/residence an (City/State/1p) P 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. Insurance Company Policy Number ( ] I am a sole proprietor and have no one working for me. [I am a sole propricto general contractor r homeowner(cirde one) and have hired the contractors listed blow whohave the following wor ' mpensation insurance policies: - •• ••• `/ fvs, �`^ 1)"l c_.) Cr / C� ( � � V�1 U Name of ContractorI / Insurance Company/Policy Number . • _... . • PG ( , c rr- &vI1 f ) � l `AJ `� `•' Name of Contractor - • • • • Insurance Company/Policy Number • • •• Name of Contractor Insurance Company/Policy Number .._ • I am a homeowner performing all the work myself. NOTE.Please be aware that while homeowner who employ persons to do maintenance.construction or repair work on a dwelling of nor 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 Worked Compensation Act(GL C. 152.sea. 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 lnsuran&for onvcragt verification and that failure to&cure coverage as required under Section 25A of MGL 152 an 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 ofS100.00aday against me. ( l p Signed this _, a C t day of `I , 19 0 P::matt: • i SIG OFI' APPLICANT: [5,:«( 14.2, c,1 I. I BUILDING PERMIT If: V( _I I ADDRESS: 31 L s j _.� rd. TELE. NO. : 153-15 .2461 DATE FILED: BLDG. SITE LOCATION: 1; s S . 5 L0,-c ei(. MAP/i: LOU: 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 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 DEPARTMENT DATE: N/A: INDUSTRIAL 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: ELM/39 PLOT PLAN . FOR LOT # • Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) e _ Well I (lot ft. rear) Abuttor's I Abutt Name ' 4N-T`b Name Lot # I • Lot # eco posed. REAR YARD /' Sl.e(t: PLOT PLAN ti FOR LOT # Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) ED Well g I I I (lot ft. rear) I Abuttor's I Abuttor' Name I Name Lot # I Lot # REAR YARD If this is a • If this corner lot, I ft. corner - write in name write i of street. I name of • is • I , other / o a• ) /a) street. w • v SIDE YARD SIDE YARD 1(-f HOUSE n . 0 FT. I • a FT.0, , .„7,41 r 1 / . SET BACK _ ,49-1 --C-- .. I 5 (,_. , r 1 0 (lot ft. frontage) \ / \ / \ (NAME OF STREET) E--- • / Information / \ \ Supplied by / MARK NORTH POINT