HomeMy WebLinkAboutBLD-93-770 ,F.Yq� oI(w.J 403
"' ,. .%. TOWN OF YARMOUTH otcFeu (Dialgff
Y'
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AMATTACM[ s" K
V,,!«ro..nt•� Application for a Permit to Build No. 770
fd /° 43 -q3
UPON FINAL APPROVAL / MAP '9-0 LOT gv-6
FEE MUST ACCOMPANYTHIS APPLICATION. - DATE /6/r 19 99
The undersigned hereby applies for a permit to build / 03/93
according� coto the following specifications �� / � /
/%1 Name of property owner -N - L— e . 9Y�� !
Address 74— / Atte - A-AlNSI4.1 (u-r 17> So . in-az. nVOu--fri
2.Name of Architect(if any) Tel.
6y3:Name of builder el c M4 -p o]Z Address/20 GP--4)t1Gc)c -7=Rnt k�_
4. License No. & 3 C Tel. 7(00 - ��o O y, b &NN iS
-T fl
5. Name of Mason Address
6. License No. Tel. n
Ofi Construction address 7J I2Rtt9K aenix vr- rZ , ' J o• ' , rc'n u-7-N-
FloodDistrict
8. Date of subdivision Approval plain zone / �L 0 one 12-1
9. Private dwelling 0 Estimated Cost /pDO NOT WRITE IN THIS SPACE
.411 Type of room No.
10. Multi family ❑ _/t o-r-e, re
/O-Id-43 K
11. Commercial 0 �'� c5-14,
`- 4, /b Kitchen
12. Other % Sro,ZR&e? ' Sfe S PEP. /0-070 Dining Rm.
13. No. of stories m G Cr-0Living Rm.
Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0o� Bath
15. Materials — Wood 0 Cement 0 Other 0 BM- /0. Deck _
16. Type of heat — Oil 0 Gas ❑ Electric 0 Other 0 Closed porch
17. Garage — 1 0 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size Garage
4-19. Storage shed — Size c x io Shed Fyio
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 /0 No. of feet side X No. of feet rear J O
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. !D /t'374 A
LOT RELEASED BY / Signature --- Z
PLANNING BOARD <i Address /�sze9llA21/41114)-taRti r 1
Date -Th , 49-A tilou 1f i-174-
Pit
Fit _ ail /0/0 53
APPLICANT: 4 1/Aet/ /9, 10,6t / 77A( 6.- BUILDING PERMIT 11:
ADDRESS: 7 S,P,9w 4z/}-frW/¢ Jakur t E. NO. : DATE FILED:
BLDG. SITE LOCATION: �/51J?j6 MAP/l: Q LOT#:
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.,$NGINEERING DEPARTMENT: _ DATE: N/A:
• (3: CONSERVATION: DATE: /n g- is N/A:
4. HEALTH DEPART - DATE: N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A:
• PLEASE NOTE •
ALL STUMPS AND/OR BRUSH MUST BE DISPOSED OF AT AN APPROVED SITE. A SIGNED RECEIPT FROM THE
DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING
PERMIT.
COMMENTS:
I
•
BLM/89
TOWN OF YARMOUTH
BUILDING DEPARTMENT
•
HOMEOWNER LICENSE EXEMPTION
.; ;
�� .-..
PLEASE PRINT:P -
Cc v- 7/415 :
DATE - ff
JOB LOCATION 7r 774-zuIt14.. / 9cu „/ O . � Dv-rfr -
NUMBER STREET ADDRESS SIECTIONOF TOWN
(X"HOMEOWNER"- /4 a ity . ajaini✓e-' Fla,
,
NAME HOME PH NE WORK PHONE
./PRESENT MAILING ADDRESS 7, J3ja)K1Q.i IAatef$tn bb..� ,/ £ 4{, vnrl-7-/9•-
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
ATTACHED 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 AID PROCEDURES AND REQUIREMENTS. .
VfiOMEOWNER'S SIGNATURE .........744
APPROVAL OF BUILDING OFFICIAL
•
INSURANCE COVERAGE:
I have a Ycurt)
es lability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
No
If you have the ked yes, please Indicate the type coverage by checking the appropriate box. '
A liability Insurance policy , Other type of Indemnity 0 Bond 0
r
OWNER'S RANCE•WAIVER:-f am aware that the licensee does not have the insurance coverage required by
Chapte the Mass. General Law . and ( my signature on this permit application waives this requirement.
/ tea one:
r nn 4 S 0 ' OwneAgent
Sign•Owner or Owner s Age .
BUILDING DEPARTMENT
• . CONSTRUCTION SUPERVISOR...FORM r'
PLEASE PRINT: _
fOB LOCATION: lc ' VAlljnvr Se• i 49 tt'`Lf `
NUMBER . . . STREET . . VI LLAGE .
OWNER OF PROPERTY: • -!- - 1.1 1 ,• •+IAJFF-1 ii AJA-.
CONSTRUCTION SUPERVISOR: , �f a , T `L 0 C13C i L o—goo '
' • NAME .'l j - LICENSE NO. t�P�HOONE NO. . ,
•
ADDRESS: . I Z.a f r.l7►C-V4-� �t$'1 t,oi 120. . __ Sj . t/�/!f I$ , / t.N. ' .
LICENSED DESIGNEE:
(IF OTHER THAN SUPERVISOR) NAME; / ,+r, r LICENSE NO.
2.15 RESPONSIBILITY OF EACH LICENSE HOLDER:
2.15.1 THE LICENSE HOLDER SHALL BE FULLY AND CO2•TLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE
IS SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE
BUILDING 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 DE".OLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING
AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE
COMMONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB-
CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. '
2.15.3 THE LICENSE HOLDER SHALL LMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE
DISCOVERY 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 ,
OTHER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL BE SUBJECT
TO RE:'OCATION OR SUSPENSION OF LICENSE BY THE BOARD.
•
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 CONSTRUCT-1::;, RECON•- .
STRUCTION, ALTERATION. REPAIR. REMOVAL OF DE•IOLITION AS REGULATED BY SECTION 109.1.: OF THE
CODE 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
ON THE RECORDS OF THE 3UILDING DEPARTMENT.
I HAVE READ AND UNDERSTAND : Y RESPONSIBILITIES UNDER THE RULES AND REGULATIONS .FOR LICENSING C:.::
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTJ_:
THE CONSTRUCTION INSP=CTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
OFFICIAL. •
INSUAANCZ COVERAGE:
I have a car , liability insurance ec:icy a:ts substantiaeeetilvatentt which meets the recu:rements of MGLth.152
Yes No Q -
•
If you have c..ec ed vas• ;fez:e ircic_:e the rice c average by checking the ac=:ceriate bcx.
i
A liability insurance pc:ic; ' JC:.`.er type of -ndemn:ty 0Send 0
C1vNE"., :NS t RAttCZ WAIVER:: -m aware !_t the :.leasee ': ^• 6'v. he i'..
C.` _. •15 2 c the. Ma:. ^ _ _ .._ . ....._ t :z .e:--r-c—^^:.e rec�:rec :•
:,; s C :ea: _._:e . ce...... __ ..._.•_.. .=z es rec :ren _.._
...._
r 'rc: ._..•?r: Cane C`c^_x c.•_.
',JJ
iGi;A:UR%: j/,'Y�i1r��i ��/14 ::JILDi::G OFF=C,aL APPROVAL:
PLOT PLAN •
FOR LOT #' •
Indicate location of garage or accessory building
Additions with dashed lines
Sewerage disposal (cesspool) ® .
. Nell
•I
(lot ft. rear)
Abuttor's G L.___._, _ Abutto
Namecd Name
Lot # r Lot #
G '
c4-‘ ,L REAR YARD
If this is a /o • If thi
corner lot, io . .ft. corse:
fie•,,,, ; • 1. . write
write in name
of street. I - •. name
a other
• -O o street
o • . ro
SIDE 'YARD SIDE YARD
• HOUSE
/n FT. f) FT •
•C]•
••
I • •
SET BACK •
•
•
• - • ft•
�
I
I
•
(Jet ft. frontage) ' ..
•
\ / (--- k 7#-Ic tAvitra kvr- P .
\ /
\ / (NAME OF STREET)
/ •
/ \\ -Information
/ \ Supplied by (----"-.
/ \
•
Suggested Affidavit for Home Improvement Contractor Permit Application
For Office Use only NME OF CITY/TOWN
Permit No. CiairID U fl-i
Date
AIEHDAVIT
• Home Improvement Contractor Law
Supplement to Permit Application
MGL c.142A requires that the"reconstruction.alteration.renovation.renair.modernization,conversion.innrovement.removal.demolition.
or construction of an addition to any pre-esisnnq owner-occumed hmldinrcontamm;at least one hut not more than four dwelline units....or
to structures which are adjacent to such restdence or huiidine be done by registered contractors,with certain exceptions,along with other
• requirements. CUM Type of Work: ` UM S7E2e.tcr I ern ^;-1 Est. Cost MOO.Address of Work 7C MIA).VIJ r_ f� 4UJVLU 1" e • S. y'san
Owner Name: f t v"1241 WW1 71 1U-6-
Date of Permit Application: /O
I hereby certify that:
Registration is not required for the following rcason(s):
,7�Work excluded by law
? J b under 51,0(X)
,&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 GUARANTY FUND UNDER MGL
c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as t cnt of the owner:
/v eft 3 7 fCs4 Q /493-7 L/
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
' •` w= COMMONWEALTH OF MASSACHUSETTS
1.---z--1r1====
-- qt DEFAIC'M T OF INDUSTRIAL ACCIDENTS
' ee 600 WASHINGTON STREET a
JamesGamoxe BOSTON,MASSACHUSETTS 02111
Cominussone WORKERS' COMPENSATION INSURANCE AFFIDAVIT
I, 7111Je ( }?_R,t o onto cT5
(licensee/perminee)
with a principal place of business/residence at:
\21.) 69_9P ie Gess e.40 ,o. S. em,' s, AAA- 0266o
(City/State/Zip)
do hereby certify, under the pains and penalties of perjury,that:
[K(' am an employer providing the following workers' compensation coverage for my employees working on this
job.
Ct �rN� rz33646 CP) C4A
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
o 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(GL C. 152,sect. 1(5)),application by a homeowner for a license
or permit may evidence the legal status of an employer under the Workers'Compensation Act.
1 understand that a copy of this statement will be forwarded to the Department of Industrial Accidents'Office of Insurance for coverage
verification and that 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 SI 500.00 and/or imprisonment of up to one year and dvii penalties in the form of a Stop Work Order and a
fine of 5100.00 a day against me.
Signed day of OCT, , 19 /Q 2
�Y /. 7i7r 1Z
Lic s�' e/Peimittet Licensor/Permit-tor