The URL can be used to link to this page

Home My WebLink AboutBLD-93-759 .01" 44 , 0,-,-,2,10/1/93 ' '�o ltW TOWN OF YARMOUTH t�K '°%/93 u, y 0th cu' /o/7/9I �e6):7140 17 'f Application for a Permit to Build No. 76 UPON FINAL APPROVAL P0_7_ —IuIAP t'r LOT -1-ca- FEEMUST ACCOMPANY THIS APPLICATION. DATE 9,? The undersigned hereby applies for a permit to build i /0 7/93 • ' according to the following specifications 1. Name of property owner 'AV QeGeo`TS /�/7 TelJ99-t7 Address /99 04.0 0 6i— cf'n r'4440af 2.Name of Architect(if any) Tel. a Name of builder SA til t .t." 4i7/l.Etc Address I'd 44'SeO• ,Ps fit 4. License No. 6277 Tel. , 79q fat 1.g 5. Name of Mason Address 6. License No. Tel. 7. Construction address /PA 61- C til At*/ Ser O. ? Flood District 8. Date of subdivision Approval • _ plain zone Zone R` , 9. Private dwelling ❑• " Estimated'bob('` ,P s DO NOT WRITE IN THIS SPACE /0-i �l p(f tiov cr t i Type of room No. 10. Multi family 0 L/.,e so- / ,L/IGE /W4-3 Kitchen 11. Commercial 0 Az oei4cfrKitchen 12. Other ;. Dining Rm. J 13. No. of stories Living Rm. S Cr t' Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 �_lper-art Da ° Bath 15. Materials — Wood 0 Cement 0 Other 0 i ast BiyL Deck 16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 0 2 ❑ (� � Family Rm. I /"'Wi``' n, Sun room 18. Swimrning pool - Size -- • . >a b ' . (/ M Garage 19. Storage shed — Size Shed 2a 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 L5. E. No. Pet, j6 LOT RELEASED BY Signature ' PLANNING BOARD Address .1 ¢eyF ds5 Date A 04'484. '/f e" 47 ,O o2 6 7 8(4- /0/I/3 -BUILDING PERMIT APPLICATION SIGN OFF . APPLICANT: 1) 6A ea' .0" Kir/jr it,, BUILDING PERMIT //: A li2 ADDRESS: p,L,d-4#CQeey/JOe4.TELE. NO. : ' DATE FILED: • BLDG. SITE LOCATION: /7 7 e2t na/"f' 57 MAPI/: 'tf",7 LOT/l: L 2. 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 C014PLIANCE 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 CJ& ./ -9; . , . DATE: '30 -9 3 _N/A: 2. ENGINEERING DEPARTMENT: I DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT DATE: %-3v^ j3 N/A: /.US RIAL 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: wI (--F' , -- _ A,-a KG�t. ) /11/4 N fl an-77,w ./' Bti, zf s--" vl r2/,YisW cc/tit/at /Ari c, . e�o- 41+1xi • BLM/89 • i • `�' �' • COMMONWEALTH OF MASSACHUSETTS e' • DEPARTMENT MEIN OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET games Campoel; BOSTON, MASSACHUSETTS 02111 . comm:ssoner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • 1, !•1 cAr,r� ,e , �R/lEL (— (licensee/permit-Etc) • • with a principal place of business/residence at: pr, 1. -4..4/45X lt' .r-s- 6 a ‘97 (City/Sum/Zip) 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 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 0 1 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 dweiiin; 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(GL C. 152,sect. 1(5)). application by a homeowner for a license or permit may evidence the legal sums of an employer under the Workers' Compensation Act I understand that a copy of this statement will bC forwarded to the Department of Industrial AcddenII'Office of Insurance for coverage verification and that failure to iecure coverage as required under Sec-don 25A'of MGL 152 can lead to tie impoiition of criminal penalties consisting of a rine of up to 51500.00 and/or imprisonment of up to one year and dvii penalties in the form of a Stop Work Order and a a. fine.of 5100.00 a day against me. y' • Signed this day of , 19 LiocntorrPcrmtror BUILDING _ CONSTRUCTION SUPERVISOR FORM LEAS'E ,PRINT: ' ' OB LOCATION: f99 Gam• O 4/ Aide j �hots-4L,9a. hots-4.,9b.-L ER . STREET VILLAGE WNER OF PROPERTY: ,10.4.. /' ,t e C 'e -7Z-5 ONSTRUCTION SUPERVISOR:: • /7. . :.4-",4,32e- • 77 £9 J9" .--.5-01, 5 NAME LICENSE NO. PHONE NO. ADDRESS: ' 8 ai A-ifs a • mP l7'VJ °- rT p9,g--.f3'. A n26f 9 ICENSED DESIGNEE: (IF OTHER,THAN SUPERVISOR) NAMELICENSE NO. .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 UILDING- 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 O:L*1ONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB- ' -ONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. ' 2.15. 3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE ISCOVERY 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 THER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL 3E SUBJECT 0 REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. n' 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-4 .- STRUCTION, ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1,1 OF THE, -ODE 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 LICENSE HOLDER IS SUBSTITUTED N THE RECORDS OF THE BUILDING DEPARTMENT. I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS .POR LICENSING CC' ..TRUC:ION SUPERVISORS IN ACCORDANCE WITH SECTION_ 109.1.1 OF THE STATE BUILDING CODE. I UNDERST:C :E CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDIN FFICIAL. • INSURANCE COVERAGE: I have a ct;rre^^t liar it inscrnce ;clic./ cr ds substantial egcivalent which meets the ren-ire.^ents cf MGL h.152 Yes tr. , No ❑ If ycu have checke-y_ flats incicate the typec;Mer - by checking the b^ Aliability insurance pc.cy C:`.ertypec .,cemnity ❑ ecnd ❑ C'NNER'C INSURANCE WAIVER: I am aware that the :..ensee dc_ ,. rat have the in_ .-.._ 152 cf the Ma_:. CenL-ws. ane at my _ _..re cn :,,. perm:: _- .,._..cn wan _rst es this reP.:irerr•_.._ 'w / 1.- e ,.. Check pre: c Cner-' Agent-9C _.gna,wo ci C..ner cc C net s:.yent • !"... . ia . T r•N. n• r r \ ' rob ,Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only , NAME OF CITY/I'O WN • Pe molt No. /d L,/H 6p-vA-2ry`off Date • AFFIDAVIT Home Improvement Contractor Law • Supplement to Permit Application MGL a 142A requires that the"reconstruction.alteration.renovation.repair,modernization.conversion•inprovement•removal.demolition. orconstruction of an addition to any pre-existing owner-occupied buildinQcontainingat least one hut not more than fourdv,elling units....or ' to structures which are adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: /'t'1n etc: GTA-.e.4,c..r Est. Cost •' ea- Address of Work /98 v 4_ 45 ,•a ei .t. Si cyco 7/, )Y"4-4l/s,A %, Owner Name: 4,14. 7" pec ec rTL� • • Date of Permit Application: 9/17o1Z? I hereby certify that: • Registration is not required for the following reason(s): • • _Work excluded by law Job under 51,000 • _Building not owner-occupied • _Owner 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 GU\RANTY FUND UNDER MGL c. 142A. tiet., • Signed under penalties of perjury: . I herebgy�apply gfor a permit as the agent of the towner: `y ��J 6//3 �irK iL� � 2702 Date Contractor Name Registration No. OR: • • • Notwithstanding the above notice, I hereby apply for a permit as the.owner of the above property: Date Owner Name • • e �5�3„ 25.6 o' )\,. .• . . ..: . .. a \a ,o • • - • • X 1 •X • X • 1 Y 1 • • 1 1 . . - - �� --- — . " - • I r4e1 • ` Isar'"+ , I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE 1 o�,�P`tPAUL A8�9C�� STANDARDS FOR THE PRACTICE OF 4. IN ACCORDANCE WITH THE BAND SURVEYING IN LOT „ _ :, AL AND TECHNICAL -: 4 - A. �Z- T�1r MMONWEALT4 OF MASSACHUSErm yt `� l( ,. . A?e'i!THE/�! s ,,,12, G k �G193 9s '?`,A• q£G c aha ,`- - PAUL A. MERITHEB; P.LS. AT N �62•493p E w~, • LOT 1 o; ASS. MAP '44, PARCEL 12 ce FLOOD ZONE "C" l • RES ZONE "RS-25" - PLAN REF: 246/60 o • LOT 2 c,„ g9'3p E • ul N 26' —62 00 w f . N. �wt3 ii. G` 9. cr ' r 2w...; — \ tts� TOWN OF w p oQ YARMOUTH �, .e t �_ 2 - o `_ ___ , , PROJECT LOCATION `-°.w 188 OLD MAIN STREET oma =__ Q SOUTH YARMOUTH =_ _ o o., ___-- ____ 1$a __ APPLICANT PATRICA DeCOST =--_____ =_ = =_= i ww (508) 394-4478 - cr. N�_ ��3 STORAGE _ _ 1 i BUILDING YANKEE SURVEY CONSULTANTS 06. 2 r �� P. O.UNIT 5, 40B INDUSTRY ROAD C. BOX 265 . MARSTONS g,Y MARSTONS MILLS, MA. 02648 • O,1 c4 TEL. 428-0055, FAX 420-5553 r ,0 NV �� SCALP? 1" = 40' DATE 8/17/93 LAWERENCE P. McGRATH • $6 1 � •• REV REV... ET. UX , o JOB NO. 50340 SHEET 1 OF 1