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Home My WebLink AboutBLD-93-752 i , YH `` - $ - ':Et ° TOWN OF YARMOUTH 0 ,r aLs- so (5•�� it._ ` MATTACC 5 r r Vi,tta.mmo. 0,; Application for a Permit to Build No. 7i- UPON FINAL APPROVAL as- Olt0� /0 MAP LOT «J 9 FEE MUST ACCOMPANY THIS APPLICATION. DATE n' + 4 19 c The undersigned hereby applies for a permi7 tp bui� _ �,� �� /0/S 9� according to the following specifications 1/��iRe__ i i /0/579 1. Name of property owner V . U, G , A )eaStd..e TeL "V174.5 3,3 Address t-; S S . SLorc d„r , 2.Name of Architect(if any) Tel. 3. Name of builder a Ie.c rt I I Address -412_, 5 k ie.-e ki.g-11-• rc4. . 4. License No. Tel. 3 5-5 - 3 so I 5. Name of Mason _ Address 4 I / i 6. License No. Telr 3 6 1137 7. Construction address V5 'S s . s Lno L, J Flood District -- 8. Date of subdivision Approval plain zone Zone R-13 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE 10. Multi family 0 .4 3 oo . u 0 s/1-C) 6f` 6.15Type of room No. 11. Commercial 1:1-nt gerkM-rff2 f(t:rnTEf - Kitchen 12. Other ❑ DoDining Rm. et - 13. No. of stories cp' Living Rm. Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath 15. Materials — Wood 0 Cement 0 Other 0 58472) eygLL Deck 16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 , D - Closed porch 17. Garage — 1 ❑ 2 ❑ 23' LArv"'"' Family Rm. Sun room 18. Swimming pool - Size j FjAE eat73 Garage 19. Storage shed — Size /NAM lo4 Shed ' SXS l 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 �� PLANNING BOARD Address Date _' COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF INDUSTRIAL ACCIDENTS . . 600 WASHINGTON STREET James Campoei, BOSTON, MASSACHUSETTS 02111 • Comm:ssioner WORKERS' COMPENSATION INSURANCE AFFIDAVIT __ • I, t) c.c�) h rrl t I • (licensee/permittee) • • with a principal place of business/residence at S (G t k . rti e {�— mac(- r� ,.-1- )) H74 (City/Scare/lip) G 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 ( j I am a sole proprietor and have no one working for me. (01I am a sole proprieto general contractor r homeowner(circle one)and have hired the contractors listed below who have the following wor ff plensation insurance policies. •- •••• • • _t• ) /l/ (/l Tom? n n P.�`•^� 1/-1 e. C c( / ` L/ U ►v `� `-' Name of Contractor II// Insurance Company/Policy� i ' Number . _•... . • Name of Contractor - • • • . • Insuance Company/Policy Number a• • • • -' • • Name of Contactor Insurance Company/Policy Number .. . • 0 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.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 Insuran¢for coverage verification and that failure to;cure coverage as required under Section 25Aof 5AGL 152 an lead to die impoiition 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 3100.00 a day against me. ( , Signed this 0.04" day of "I . 19 p P :.icer..._:Pe 5 .....asp:Fearer-.,,. SIGN OFF APPLICANT: acerb Pke.rei t I BUILDING PERMIT 1/: ADDRESS: "SO__ S k _ ,f13. TELE. NO. : 3 0 -1461 DATE FILED: BLDG. SITE LOCATION: 131 S . 5 L0.c d r. MAP//: LOTH: • 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. PLU`BING 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: BLM/39 PLOT PLAN • FOR LOT if • Indicate location of garage or accessory building Additions with dashed lines . Sewerage disposal (cesspool) Well . I (lot ft. rear) Abuttor's I Abutt Name ' 4;% I Name Lot # Xs ILot• n • Pro PSS EN� REAR YARD SLeS- If this is a • If tl ' corner lot, — l ft. corse write in name writ of street. I name ;; • I a, othe • C" 4P c stree •ecI • ' . 4 SIDE YARD . 4 31 SIDE YARD • HOUS 0 FTQ 0FT. 0 . , .p. • • I , I SET BACK •I I (lot ft. frontage) • \ / \ / N / (NAME OF STREET) . / . • • A . / / `\ -Information / \ \ Supplied by PLOT PLAN ef FOR LOT # Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) • Well 0 • 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 I write ± • of street. I name of A-. • I P. other �• aai street. P v ft, SIDE YARD SIDE YARD 1(-+ HOUSE f� f i FT. I FT� :et— .t. / . I • I , SET BACK , sc ., I S .(,_ I 0 (lot ft. frontage) \ / \ / \ / (NAME OF STREET) • / Information / \ \ Supplied by / MARK NORTH POINT