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BLD-93-764
e . 6 i 9/,3193 it • %kms= 6 o TOWN OF YARMOUTH © Few 9/K/3 o plk( � /' '• MATTACHCCS v karma", Application fo�rr,a Permit to Build No. le UPON FINAL APPROVAL �� I� v"/��MAP g.L2G LOT / _7 FEE MUST ACCOMPANY THIS APPLICATION. \DATE friC 1G9 93 The undersigned hereby applies for a permit to build /r/may -3 according to the following specifications Am./ti /v/a/93 1. Name of property owner Q au k A 1 t►� Tel.8132- 9/33 Address 70P7 tMmia1 fttnbuew Ytts4 2.Name of Architect(if any) Sp in p: Tel. \.3. Name of builder Shrn r Address 4. License No. Tel. 5. Name of Mason Address 6. License No. Tel. \7. Construction address 11l PMwkfO4v/valit 1k S. Yprani .Y-h. Flood District 8. Date of subdivision Approval plain zone �/2_64. la,� Zone i?..aC 9. Private dwelling Z Estimated Cost pd. DO NOT WRITE IN THIS SPACE ?rsrJ�d'ic" Type of room No. . 10. Multi family 0 1 flap, H 9I' z 11. Commercial 0 G(r/Z d,�;e J e ift- 0-6Kitchen 12. Other ❑ ei 0 �,c_o DSP Dining Rm. Living Rm. 13. No. of stories I / a..,- ' �'�/' Bed Rm. 14. Foundation — Full 0 Half 0 Crawl /Slab 0 Bath 15. Materials — Wood Er Cement 0 Other 0 Deck G.44,23-f- I 16. Type of heat — Oil 0 Gas 2/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 23. 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. A Ctiz%. LOT RELEASED BY \Signature PLANNING BOARD , Address 'DO /J7.�fr✓ S.$ Date £AJvJacr c,r MA/TS Q Mo t BUILDING PERMIT APPLICATION SIGN OFF APPLICAFIl: 9IQJ ` Al s\1 N) BUILDING PERMIT 1/: ADDRESS: /08 (MIOIw., T „ANO 9V TELE. NO. : g32"q/33 DATE FILED: CJPi/SJ BLDG. SITE LOCATION: Lj j PAwtWkti 1M A- ®U. MAP//: 2v 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, Z.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: 9—/0-9-3 N/A: I STR 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: BLM/89 TOWN OF YAMOUTH BUILDING DEPARTMENT • HOMEOWNER LICENSE EXEMPTION • PLEASE PRINT: • DATE cl/c/V • JOB LOCATIONL} ) rzr) Sb-4 0ti S. y � � pkg► ov� N USER STREET ADDRESS SECTION OF;TOWN "HOMEOWNER" 1%,A 1AIn\tr„ q1)2- 9133 93)- 3(37A • NAME HOME PHONE WORK PHONE • PRESENT MAILING ADRESS -70 8 I/Ii 14 I c S LvolxP w 0/1455 01801 CITY OR TOWN STATE ZIP CODE THE CURRENT EXE.MP'TION FOR "HOMEOWNER" WAS EXTENDED TO INCLUDE OWNER—OCCUPIED • ' DWELLINGS OF SIX UNITS OR LESS AND TO ALLOW SUCH HOMEOWNERS TO ENGAGE AN IN— DIVIDUAL FOR HIRE WHO DOES NOT POSSESS A LICENSE, PROVIDED THAT THE OWNER • ACTS AS SUPERVISOR. (STATE BUILDING CODE SECTION 109.1.1) DEFINITION OF HOMEOWNER: PERSON(S) WHO OWNS A PARCEL OF LAND ON WHICH HE/SHE RESIDES OR INTENDS TO RE— SIDE, ON WIIICII THERE IS, OR IS INTENDED TO BE A ONE TO SIX FAMILY DWELLING, ATTACHED OR DETACHED STRUCTURES ACCESSORY 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 REGULATIONS. • TILE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF 'YARMOUTH BUILDING DEPARTMENT MINIMUM •INSPECTION PROCEDURES AND REQUIREMENTS AND THAT He/SHE WILL COMPLY WITH SAID PROCEDURES AND REQUIREMENTS. ' HOMEOWNER'S SIGNATURE cyact4..t._/ C/t+ru APPROVAL OF BUILDING OFFICIAL NOTE: THREE FAMILY DWELLINGS 35,000 CUBIC FEET, OR LARGER, WILL BE REQUIRED TO COMPLY WITH STATE BUILDING CODE SECTION 127.0, CONSTRUCTION CONTROL. IINSURANCE COVERAGE: I have current liabilityinsurance policy cr its substantial equivalent which meets the requirements of MGL Ch. 142. • Yes 0 No u If ycu have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance pc:icy 0 Other type cf indemnity 0 Bond 0 OWNER'S INSURANCE WAIVER: I am aware thatthe licensee does rot have the insurance ccve:ace required by Chapter 142 of the Mass. General Lays, and that my signature cn this perm„ appfc_ticn waives this requirement. I ' Ctieck cr.e: Cvin'er ❑ Agent 0 C'..LC! a Benter s n:=... _ ' -__ - _•_ PLOT PLAN • • • FOR LOT •# • Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) Well • II • (lot ft. rear) Abuttor's I / Abu Name f) ' ) 1O Nam Lot # Lot t REAR YA• e i If this is a4 t /3 -4 Ift corner lot, - corn write in name i 44 TWri of street. b• - ) 1 c..1.0I nam I ` I o a .•othe l�cr _ ` I _ (-0 aa) stre • • 'A SIDE YARD . SIOE YARD HOUSE thr FT. r0 • �] -- �- - - FT.ii) • - w.,-c, • 0 • • • • � ;Kit SET BACK• 4f • • 1 39 • ft• u a. • . • � S I G ,a, • grow, Ptore Y Lrkilt 2 J , (lot tit. frontagge) .. • • \ / ,7l P wai1/4/W ' � tt_ Si. Tfgh,ovkik \ / \ / (NAME OF STREET) \ < • . h • / / \\ Isformat by NJ ( Nit%IuIQ / \ • • • COMMONWEALTH OF MASSACHUSETTS g " DEPARTMENT MEIN OF INDUSTRIAL ACCIDENTS 1 600 WASHINGTON STREET James Canine!' BOSTON, MASSACHUSETTS 02111 . Co WORKERS' COMPENSATION INSURANCE AFFIDAVIT • I, P10V I Ph ?f W • (Iicensee/perminee) • with a principal place of business/residence at: '708 lentilkJ <S+ LuohuQe✓ t /II19JJ n / 8oi' (City/Sure/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 wt Name f Contractor • Insurance Company/Policy Number I am a homeowner performing all the work myself. NOTE.Please be aware that while bomeowners who'empioy persons to do maintenance,construction or repair work on a dweiiing 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.net 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 Aeddend Office of Insurance for coverage verification and that faiiure to iceure cove;_te as required under Section 25A'of MCI. 152 can lead to the imposition of criminal penalties consisting of a fine of up to 5I 500.00 and/or imprisonment of up to one year and dw penalties in the form of a Stop Work Order and a fine of 5100.00 a day against me. • Signed this S-ep-i day of /0 , 19 93 401 :.icensetiPe.mta__ LicerzoriPermiztor • • Suggested Affidavit for Home Improvement Contractor Permit Application For Omce'Use Only NAME OF CITY/TOWN Permit No. Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.I42A requires that the"reconstruct ion.alteration.renovation.repair,modernization,conversion.inprovement,removal,demolition. or construction Man addition to any pre-cxistin¢owneroccuoied buddinQcontainin¢at least one but not more than rourdwellin¢units....or to structures which are adjacent to such residence or build in a"be done by registered contractors,with certain aceptions,along with other requirements. Type of Work: j;C K Est. Cost BOO ad Address of Work H CiAt....) tiitiunt43,ku } QR Owner Name: Pi u1 gIA ' tk/ • Date of Permit Application: 9/9/93 I hereby certify that: Registration is not required for the following rcason(s): • _Work excluded by law iob under 51,000 _Building not owner-occupied ✓t5wner 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 "" e. I42A. Siened under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstandingotthe aboveb�notice, I hereby apply for a permit as the owner of the above property: DStca/q, �"awfe, Owner Name a Nqh a -aOoCj I -y V i . .•0t„?; I U / • - -r j • �_ re f C i 70 - ssnl+po. -1 - . i / Se b �avN� a3$ ! .j , al. • • • cv-ct gmtuvi 1111 5jqQ.T tc.t ti1/47G- -r- a 7-ea 9,-r 16„ GRA n 3140 1-1-1 _ • Ar. I /0 koors • C 06-S •S PC fl 0 &jig P. T EntA-N Suit + u0 • a lei PS CP iow.% /GIL O. Po0 r;/ye- CoLic rt 3o coP s..27. • • sly P. 7- Ec /kJ& 3'k bias • - - ---------