HomeMy WebLinkAboutBLD-93-762 `, 'c TOWN OF YARMOUTH � ��i°%��3
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. .. Application for a Permit to Build No. 76.
Pol ,o,, "_93
UPON FINAL APPROVAL / MAP i 3 LOT N tr
FEE MUST ACCOMPANY THIS APPLICATION. DATE /o/ r 19 'qk3
Theundersigned hereby applies for a permit to build /dY7�7-3
ac ording to the following specifications
1. Name of property-owner &tr ff r AM (le iii,I C° -2A ./r/d/9c3A Tel. 77/ --/e4/7
✓Address 02.? Lc/76 119. �• VA+ MO aril
2.Name of Architect(if any) /� Tel.
‘4. Name of builder co ///A Pil M(nil Address 27 JCRe 6)A M. 40. MR/Yet
,74
4. License No. Tel.
5. Name of Mason _Address
6. License No. Tel.
17. Construction address -27 .&R " '-ieRe/v-4 0 w. YAR rtd6)7
il
Flood ci District k _,.
8. Date of subdivision Approval plain zone Zone
9. Private dwelling ❑ Estimated Cost DO NOT WRITE IN THIS SPACE
� co Type of room No.
✓
10. Multi family ❑ a /69-00,
Rita f- STS l r. n I� Ti+1g S 1
11. Commercial 0 FE 1.7 19A-pa ii' Kitctfen
12. Other ❑ Our 71 Coa Dining Rm.
Living Rm.
13. No. of stories , . '¢o • Bed Rm.
14. Foundation — Full ❑ Half 0 Crawl ❑ 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
Family Rm.
17. Garage — 1 ❑ 2 ❑ 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. _
LOT RELEASED BY Signaa re Gaarr-, (/, -f,%/e
PLANNING BOARD I Address a7 /eiQe''rJ f "
Date GU, YARnevT/r HA . 6)2673
TOWN OF YARMOUTH
BUILDING DEPARTMENT
$
' HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE /O - 7 - 73 l
JOB LOCATION a7 LOQP'�A ,iD• ittJ��rf� +fOU�/7
NUMBER STREET ADDRESS SECTION OF TOWN
"HOMEOWNER" V//4,4M ref?rc0,A 77i-/e 7
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS £7 1.ORca'A j 1
o- YAelle co-/ M,y 0.26 '3
CITY OR TOWN STATE 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
ATTACHE 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 WIT#i SAID PROCEDURES AND REQUIREMENTS.
lx
HOMEOWNER'S SIGNATURE eI7ai.n (CeiuLc r,
APPROVAL OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a current Iiabuity Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ❑ No ❑
If you have checked.y , please indicate the type coverage by checking the appropriate box.
A liability Insurance policy 0 Other 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.
Check one:
Owner 0 Agent 0
Signature at Owner cr Omer s Anent
Suggested Affidavit for Home Improvement Contractor Permit Application
For Office Use Only NAME OF CITY/TOWN
Permit No. --
Date
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c.142A requires that the"reconstruction,alteration,renovation.repair,modernization.conversion.inpmvement,removal,demolition,
or construction of an addition to anv pre-existing owner-occupied building containing at least one but not more than fourdwelling 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: S+r iv'r -r` Re Rao'f Est. Cost
Address of Work .2 9 ,Co Re1c/A npc/ ID, YAR n o u r4
Owner Name: \A/, /t/4 M l c°R iCc IA
Date of Permit Application:
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 -
4-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 GUARANTY FUND UNDER MGL
c. 142A.
Signed 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 per it as the owner of the above property:
/0 - 7- 93 cJ /6itic-t
Date Owner Name