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Home My WebLink AboutBLD-93-767 ;61'llk , 6,-- ,e/ -;; 44-_re TOWN OF YARMOUTH /24 Y U ii,:ik�4 H G MATTAC ME 5 �+ °'"°attof% ,/ Applicp ion for a Permit to Build No. 76 7 UPON FINAL APPROVAL iv l''-` .9,3MAP SSD LOT r ?-Iy FEE MUST ACCOMPANY THIS APPLICATION. DATE /4/ /� 19 9L1 The undersigned hereby applies for a permit to build /D//c% according to the following specifications c/(Name of property owner �.Pz O Jc k k1. 2c CnR m 4 r K Tel. 399 ,9G4Address 7.2, Cu to E M.'i/ R So i` 4Rw+o 0112/4,2.Name of Architect(if any) VV Tel. 3. Name of builder atoMz2 Address 4. License No. Tel. 5. Name of Mason _address 6. License No. _ Tel. 1-1,11 v7. Construction address 9.2 Cu K v c V. sc. /} K1-70,77 Flood �C--- 12 Distric /G 8. Date of subdivision Approval plain zone Zone 7 9. Private dwelling 0 Estimated CostDO NOT WRITE IN THIS SPACE 5/rip- 'F ere,F Type of room No. 10. Multi family 0 L.--- �3 0 Co.o o fftpciz.- l .,vr POSE 11. Commercial ❑ �S �� Kitchen 12. Other I s Apt r -d (,L2.--'.�- Dining Rm. x..22 Living Rm. 13. No. of stories Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 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 17. Garage — 1 ❑ 2 ❑ _. Family Rm. Sun room 18. Swimming pool - Size Garage 19. Storage shed — Size Shed 2a 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. ie. tic10-104..,,, LOT RELEASED BY Signaturec. �.e_ . •. i PLANNING BOARD C— Address 7 2( moo, Date _ dot An..e j Wcz p 44.7 TOWN OF YARMOUTH BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: • CDATE AQ//oA/9 ] / / y /w'. 16B LOCATION 72 CURI/F ,Y'LL s&. q i" GU NUMBER STREET ADDRESS SEC ON OF TOWN ��OMEOWNER" �P£c/�iP /C/� Ir/ y,..t 6R QAC /C� / 'SI N1KMgEEE HOME PHOE RK PHONE r/ PRESENT MAILING ADDRESS 7 2 C{1 KV G fl,-41 potQ WO So . (4/(k140 r—Th /t. .62415/ CITY OR TOWN l( 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 WITH SAID PROCEDURES AND REQUIREMENTS. vFfOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL • INSURANCE COVERAGE: I have a current. pity Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yeses No ❑ If you hay checked Les, please indicate the type coverage by checking the appropriate box. A(lability Insurance policy 0 Other type of Indemnity 0 Bond ❑ OWNER'S INSURANCE-WAIVER:-1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my ignature on this permit application waives this requirement. Check one: Owner Agent 0 ,.Signature of • er a Ovmer s Acent • • • • . • • • In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c Ill, S • 150A. - The debris will be disposed of in: - - • • Ili. (1 Lpcil49: 11 • (Location of Facility) • • Signature of ....it App liwnt /0/a0S Date t-- COMMONWEALTH OF MASSACHUSETTS =- ccs _ . . -- .- - , -- — - DEPARTMENT OF LNDUSTRIAL ACCIDENTS -- •-` `--- -----� • 600 WASHINGTON STREET JamesCa nooei, BOSTON, MASSACHUSETTS 02111 Com .ssoner mWORKERS' COMPENSATION INSURANCE AFFIDAVIT • 1, r/ fr tic-t e (licensee/perm i tree) - • with a principal place of business/resident ce at: (if� /Sute/Zip) - do hereby certify, under the pains and penalties of perjury, that: I J lam an employer providing the following workers' compensation coverage for my employees working on this job. I Insurance Company Policy Number [ j I am a sole proprietor and have no one working for me. \. [ ) I am a sole proprietor, general contractor +(circle one)and have hired the contractors listed below ..• who have the following workers' compensation insurance policies: -- - - -- Name of Contractor - - . Insurance Co�I pany/Poliry : Number.. Name of Contractor Insurance Coipany/Policy Number . . - . . .. Name of Contractor Insurance Com any/Policy Number . - ge 1 am a homeowner performing all the work myself. - NOTE.Please be aware that while homeowners who employ persons to do maintenance,tconstruction 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,sect. 1(5)). lapplication by a homeowner for a license or permit may evidence the legal status of an employer under the Workers' Compensation Mt. I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents'Office of Insurance for coverage verification and Mat failure to secure coverage as required under Section 25A'of MGL 152 can lead to the imposition of criminal penalties • consisting of a fine of up to SI500.00 and/or imprisonment of up to one year and civil penairiesllin the form of a Stop Work Order and a fine of 5100.00 a day against me. Signed this /' day of OE (I , 19 2 7 2.... :=2(24...../"lePrz...€0,-......./- \ Liccnsec:Permirret' L:censoriPermictor • Suggested Affidavit for Home Improvement Contractor Permit pplication For Office Use Only NAME OF CITY/TOWN Permit No. - 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 building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or budding"be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: /Wu / I p LEst. Cost�3200,00 c---Address of Work 7.1 &U Cu c I r t LL 1)J �v • r AIZwt n L, j h --Owner Name: R:£ Ric /t . cC 'pPtrrnAe�� U Hate of Permit Application: /G//.2 14.E I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under SI,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 NOTHAVE • 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 permit as the owner of the above property: Da J� Owner Nam