HomeMy WebLinkAboutBLD-93-771 Y 4 '° /m/,)7�
;6 ei
-~ ��� &, . . TOWN OF YARMOUTH o,K. FE•W'
0 —yt;
• MATTACMC
,_<«,...,S0,- Application for a Permit to Build No. 7
UPON FINAL APPROVAL � I�/13 MAP 33 LOT i9`
FEE MUST ACCOMPANY THIS APPLICATION. DATE Si/r{- /1 19 9
The undersigned hereby applies for a permit to build /0/5/93 '
according to the following specifications /b( i3'0
1. Name of property owner Ines M,a kc c*tc- jb/i'JM0 Tel. 149,-6/6y
' . . Address 31 'Pheoa'.x S-Ert¢ab Flo AV J r 21/1 A- 027!9
2.Name ofArchitect(ifany) ._ .._. Tel. ,
3. Name of builder .co. * 1 - II - 'ddress `79 .Senna km LA) I ()YJU2AI� n/tA
4. License No. 057/ 7/ Tel. (SoSt 3-C_<70
5. Name of Mason s T`T y aalr(7Lo.-a7onn \
6. License No: - ' " Tel. �/i
7. Construction address q1 f04/4r/ 004' WICAl �444,o✓ I '� 6z4 73
Flood I District 7)
8. Date of subdivision Approval plain zone C Zone 7
9. Private dwelling Estimated Cost )0 5-:pi DO NOT WRITE IN THIS SPACE
Jr 0,00)Fe, r /3'/qs Palo Type of room No.
10. Multi family 0 3600.00 M $1
11. Commercial 0 , / �-- S Kitchen
12. Other Fl /3 wife`¢ "`� 76£� 77 Dining Rm.
' _ Living Rm.
13. No. of stories / 75-taiktirrfiv / 92 co Bed Rm.
14. Foundation — Full 0 Half ❑ Crawl ❑ Slab ❑ / ® O-C Bath )
15. Materials — Wood.® Cement ❑ Other ❑ / Zd 5/6RA )
16. Type of heat — Oil 0 Gas ❑ Electric 0 Other 0 / 9 ' Closed porch
17. Garage — 1 ❑ 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size Garage
r'''''<19:Storage shed —Size • r. 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
5. H.I.C.R. No.P1pfAsc.m /a al At /oh/93
LOT RELEASED BY, . Signature g .se --< 2
/
--7
PLANNING/BOARD ' , ' Address r ? PZi /G_7
0 c/ l
Date Lae>1 201. v n d dit 0 7— Co 3
inAS3 • FEC. ,
BUILDING PERMIT APPLICATION SIGN OFF
APPLICANT: BUILDING PERMIT #:
ADDRESS: 9/ /3472/4/ fJ1&A r J TELE. NO. : • } DATE FILEED:
BLDG. SITE LOCATION: d 9/ /Z%4 . � y 4'/ MAP/l: >1 LOT/l: T9
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 REQUI aINTS 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 i/j 4,.iA 6. DATE: 9-•,,,24/-9_3 N/A:
2. ENGINEERING DEPARTMENT: DATE: N/A:
3. CONSERVATION: DATE: J N/A:
4. HEALTH DEPARTMENT DATE: /d J 7/4'3 N/A:
104\• INDUSTRIAL D/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: ' A 4'1-7--F? - me _ -;A(2.- BASF_M,EUT ?arwA-rJovs . / &4;7F
n
- la r__:._Y'
yraw /intr iaion
� i ese rat
cif, ' .0 / 0D RS of .
, L au ?NE t2. 1'••a.t aatbOIJ /6 rer g
BLM/89
ciet;
v��
TOWN OF YARMOUTH
" • BUILDING DEPARTMENT •
. CONSTRUCTION SUPERVISOR FORM
' PLEASE PRINT: ' . n ' // �(J
• JOB LOCATION: q I /�Gt2�'//(b/�f Ve ll2 _/�[X 141. tVnn,oJ"1 •
NUMBER' .'O I, STREET VILLAGE
' OWNER OF PROPERTY: ' J �t sAlice . i -
CONSTRUCTION SUPERVISOR: .6 Leo C/{CCt' • • '
/ LL
��NA, ( / / . Ufa `., ,•. LICENNSE NO. PHONE NO.
• ADDRESS: • 6 7 y 2 !/Ce-[�" <it�. Wit l• 11E/I �t r_✓i/'� d�73'
di- y.
- LICENSED DESIGNEE:
(IF OTHER.THAN SUPERVISOR) NAME LICENSE NO. 057
•.)V / .
2.15 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
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 DEMOLITION 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 IMMEDIATELY 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 3E SUBJECT
TO REVOCATION 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 CONSTRUCTION,' RECON-
STRUCTION, ALTERATION, REPAIR, REMOVAL OF DEMOLITION 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 L`fl(EDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED
• ON THE RECORDS OF THE BUILDING DEPARTYINT.
• I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR :ICENSING CC:1-
STRUCTION SUPERVISORS IN ACCORDANCE :LITH SECTION 109.1.1 OF THE STATE BUILDING 'CODE. I UNDERSTAN:
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
OFFICIAL. .
INSURANCE COVERAGE: •.. • . .
I have a curren liability insurance pclicy or its substantial equivalent which meets the requirements of MGLth.152
•.Yes . ::•� No ❑
If you have checked v_s, please indicate the type c:•rerage by checking the appropriate bcx. .-:• - i
A liability ��
insurance pclicy D:her type of Indemnity❑ "•• blond 0
. OWNER'S INSURANCE WAIVER:1 am aware that the licensee dcei not hav? the insurance cover;e requirec':y
Capter 52 of the Mass. General lbs• ana that my sigh:ture cn this-permit permit ceplice:ien waives this requirerrer.:
'
p • Check one:
s,XC� � OwnerO Agent
.eat Owner Owner snt
SIGNATURE ] r UILDING OFFICIAL APPROVAL:
•
. .. .. _ . .. . .
4 ......_.e MID—CAPE HOME CENTER 5065635039 P. 02
THE COMMONWEALTH OF MASSACHUSETtS
Board of Building Regulations and Standards Transaction No.
One Ashburton Place •Room 1301
'V _—: -1 Boston, Massachusetts 02108 •
=moi b Registration No.
'4? Application for Registration as a
E[fective Date
+_ Home Improvement Contractor or Subcontractor
,w MGL Chapter 142A, CMR 780-6 Expiration Date
FOR OFFICE VSB ONLY
Date
1. Name 704,04c.,..) �060E.. 661,,
Pri the name of he individual or business applying for the registration(not both)
2. Mailing Address 7 cI rJ/A-//l *,ec.L e-941-1 id= - (son 5-0 • .5"70
may., Area Code do Telephone Number
3. City TOC4SS%r State "/4 Zip 0.71777
4. Street Address(if different) c-474,-, /-
•
(7on street and umber(P.O.Box not acceptable) City State Zip
5. Applicant type: I1Q Individual ❑_DBA 0 Partnership 0 Trust 0 Private Corporation 0 Public Corporation
(See instructions on back regarding enclosing a city or town registration under the DHA or"fictitious name"law•MGL c 110,as 5&6)
6. Social Security or Federal ID Number ) 17—rep —6 9 6'3 (see Instructions) 7. Number of Employees C
S. Indhidual responsible for Home Improvement Contracts 7 &F,2 65/ 7,)°,e,_/,...:›7,)°,e,_/,...:› /�y7 2(7-yet-6763
Last Fiat Mi Social Security No.
9. Title of individual responsible for Home Improvement Contracts 'tt.i Ac \� 11O4 C,4 G ce
10. Does the applicant or responsible individual hold any other construction related state,city,town licenses or registrations? 0 0
If yes,complete the table below. Use additional paper if necessary. Yet No
'type license or registration Issued By License or Expiration Name of License Holder
registration number Date
ire .Gc•.y7,tcolrw./Pa sthr> y =i/)rl9y J�d�,4r,1� t�v6F,CGt'1.
II. List all partners, trustees,officers,directors and major owners(10%or greater of ownership)of an applicant partnership or corporation below.Use
additional paper if necessary.(See instructions on back) Check here if you wish to receive an application for additional ID cards for key persons.❑
Last -.First." Middle initial ' 'Title in Applicant Business %Owner . Address
12. Is the applicant claiming exemption from the registration fee? (Sec the instructions on the back) 0
If yes,include a copy of a current Construction Supervisor license or motor vehicle repair shop license or registration. Yes No
13. Registration fee enclosed: S Guaranty Fund fee enclosed:S /0 O. 0 v
Include two separate certified checks or money orders•one marked"Registration Fee;one marked"Guaranty Fund". ALL APPLICANTS MUST
INCLUDE A GUARANTY FUND FEE EVEN IF EXEMPT FROM THE REGISTRATION FE&See instructions on back for amount of fees.
Make all certified checks or money orders payable to"Commonwealth of Massachusetts"
Pursuant to Massachusetts General Laws Chapter 62C section 49A,1 certify under the penalties of perjury that 1,
totmy knowbe e and belief,have filed all state In returns and paid allstate taxes required under law.
� CC-"•'ne,te•70.0
Sigpe ure of applica r applicant's r resentative Title held with applicant
A false answer to any question in this application constitutes grounds for suspension or revocation of the applicant's registration.
1
•
. MID—CAPE HOME CENTER 3035635039 P, 03 _
..: �•
, • The$an Ch . , t+,•(.y
t �39553' :
14% .• ,
otiperartivelititnk
. u�� �}ice S x4
. • Sandwich, MA 02563 S " iS � •;1
OCT 0439 4'� '"'t :�'�,
PAY 1
TO THE C 0a /S1 U. cs.ei'At.1lV A/� •.;..s' :» ;;
ORDEROF 'trTAWAnnSODAYS: •' ": , X t
) NOT t0 EXCEED 11000 00 • {{^may' T.iF./y/
H f. •.,713 1'.46.:F%?�0e,t 3
MONEY ORDER' S. 1 00 . 00 � , ,
., S y1 .'r1s Z;F*.
DRAWER a � T' 'Cl �,4 .
ADDRESS 77 /.E.e,E.4.t r e..4...,.. •t ,1.tx
1
J^ ...___J. 11' 39553711' I: Zii. 37 /900g: 03 050000711' •
•
0. .r«.....«.---_"^---•.•.y,,
DEPARTMENT OF PUBLIC SAFETYs
1010 COMMONWEALTH AVE. [iI
BOSTON,MA 02215
LICENSE •
CONSTR. SUPERVISOR •
- EFFECTIVE DATE LIC410.
05/31/1992 051171
xDONALD DUDERGER
POC ASSETO3 MA 02559 � '
•
•
Not WV UNTIL stamp W taNOet ANO Orriafttr
STAWEO.OP•raNATUPC Of 1NE CCMMSSIONEP
/1 (' ,l
, 1IUryE tcfNMEI
//��1 CQwy (,OAM55gNEP
„0 T 2 08:57AM DROLLET / &OLONY . /
s� w 7 •co LL1rrI.AAlL� EA EoTATE•&CCY43T. P.2
C6IC/AJe,AVIMHLY , •
rcrr.lt • . , /o>`n.2
,e• 30
`i • 4033 Fiberglass J T , C7/ J
rail t••..w•• insulation �/ T• !2! G�ed
-dep,9
p 0.
; 1ll��yiAyIM •rltt• /�a
�e . .tO i • •
twits I .45 6EMALY
i.„.•••••”" : rvrrt4 l
is _ fl. It.S. • •
-mist �" If• got
. .
I"
✓• I:i
2j
'.��� : I�,,-n lea• r•w�ne+ DOOR & WINDOW AREA PERCENTAGE
•
%" i !.�j"N;a {reina Exterior wall area F24.4:, sq. ft.
I•
Fiberglass ft = Window & door area $/ sq. ft.
! � Insulation ---- Window & door Exterior Wall % off
1•. .
C: _ 2•, area area
g' . • Fab . . „ ,,
isle64
:,'.:. I h (C, 4
R= II
,; I IFiberg ss , •
: I re
ll.
Insulation . IF MORE THAN 15% CONTACT BUILDING INSPECTOR
wail abash! _
`. C~^
7 — R- I ii` real 1L MO* Ae-eri OrJ1.
. TALJLE 2009.1
MAXIMUM U VALUES
AND MINIMUM R ' VALUES •
1L111W ) PUUCRIf1100 • V TOTAl. Morn!
,MM'S ■ TAUT
wall' All wall eesslgntU.. ...t.Is!•t ',or MO I
Pigsty/ •r ...h.rlt.11p e.tlee
rt!!!
- ,•
• 4lecicFiil■{nii6,,il; c003 -Ir -- UT •. In i.e . hpph . •
. 1..111 p.vi pia
, kW. lu !fclul- cep f It
Di ria'. J. tl fe.�te,l�n,! enl. .ltd !Inv _ o so/ tel. —J1—.-
. sent.Illnl An enl tenilUu,tI.s tinl.lnln! "OM) JO.
Aret4el _ Mrttd or ntehrnlifitee t1 t .e1
Il • 'Wm entinlnt huts{ CO 1.4/ 3
t1 ;.fcMtic.Ii1 eOOIl_�.lr?!t _ '_
lltcllle g.lfUpt 'MENU.. S3D
• .Ce•tI • Ail A._/1...._-. L._ 3.59 a, 1
AlJ e.ng Uutt lrs .ntl•r lnl A O.M /g•
et /44ehulttllJ-tee142 fpict ��
rl•rll riteitciiel. .itr Intif t�retti iI-- jmo -'r-
Ie_sulIldi Ill et rtiltd !pi!! ��
;lob en lridt► h ce
tpnnhtlsllthntd •"lr 3
•
It 40_144t (-612.-#7 ,,,c
•
(41.IQRm 0 a
•
w
11- M- ---
111111111 ..til__ 1
. .1 • 1 4 csjailiiiiallit 3 .--- .....------- 1- 6 i --....--- ...
krui yrgross is. ' •
ii, 1/4,..
Kti ‘-',_ .
LJ.. .
{ , *„...---- . (w
rn
A
1 .-1•1 �I
. / . .5
ir
1IAI , � W
40 e-
i.
la . .. i N /
' I
Thyl . /tilt?".: _ -9•It) ?,
r ...
- .1
' 'M t COMMONWEALTH OF MASSACHUSETTS
r.'
__Ec,_ DEPARTMENT OF INDUSTRIAL ACCIDENTS •
, ' . 600 WASHINGTON STREET
James J CampbellBOSTON, MASSACHUSETTS 02111 - •
Comm:sstoner WORKERS' COMPENSATION INSURANCE FFIDAVIT •
NVekCC 1I
1
(li ensee/permiflee)
• wi a principal placeCof business/residence at • (� /�
/ l(//7NcLi 1_0 we � �jOLt✓1�"c f lAil '
(City/State/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
.s,
I am a sole proprietor and have no one working for me.
( ) I am a sole proprietor, genera] 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
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 fora 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 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 51500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a day against me. s I /
•
Signed this ,� L ' 4I ~ day off/ , 19
Licer:se:iPermittet. LicensoriPermittor
• Suggested Affidavit for Home Improvement Contractor Permit Application
•
- For Office Use only ' ..:=^ : -NAME OF CITY/I-OWN'
Permit No. ei1/4 rnoeii—L"\
Date
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGLc.142A requires that the"reconstruction,alteration.renovation.repair.modernization.conversion,inprovement,removal.demolition.
orconstruction of an addition to anv 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 building"be done by registered contractors,with certain exceptions,along with other
requirements. - /1 t�
/�
Type of Work:. - Re 4-1"istiIAta D4ssvt-,ax,t' -Est. cost 3,006
Address of Work p 9/ >'4R4Rl1 e Ub/�y Ref , L • G2vtno�*�t
Owner Name: Mp . 4\ i� \jevd\gt �-
Date of Permit Application: LSeck 20 / /9 9'3
I hereby certify that:
Registration is not required for the following reason(s): •
• -
Work excluded by law
Job under $1,000 . •
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 GUARANTY FUND UNDER MGL
c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
ao 3 t/1-2� -x � — Ftt..ts 52 la//9y
D e Co tractor Name Registration No.
OR: •
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
Date Owner Name
•
j4lj;. •
t Y. „ e.w $. -.•