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He"4o,..�.$5 f—y'� Application for a Permit to Build No. 78/
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190
UPON FINAL APPROVAL 1 ) '9� MAP 74- LOT 3 13
FEE MUST ACCOMPANY THIS APPLICATION. DATE Io / /2 19 9 3
The undersigned hereby applies for a permit to build /0/i �93
according to the following specifications 16� ,l?zo I
1. Name ofproperty owner Genn e C temv-pLy Tel. 99a—„na4-
Address la Pan.- Pr Aiu.Alb r N. S. rile, T9
2.Name of Architect(if any) Tel.
3. Name of builder Onu;.J F .4-cam S Address 341-1tiior, s+ Vai- Porf
4. License No. coI939 Tel. Sob — 3t a - 911 I
5. Name of Mason _ Address
6. License No. Tel.
7. Construction address . _ di h. -
loud District grit()
8. Date of subdivision Approval plain zone Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
Type of room No.
10. Multi family 0 3 sae 0 _
11. Commercial 0 0 f /O�5/y3 Kitchen
12. Other ❑ ar ��� 37/26tillici, Dining Rm.
II
13. No. of stories 0 W
/II/ Living Rm.
Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 �� Bath
15. Materials — Wood 0 Cement 0 Other 0
J ” Deck
16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 „ Closed porch
17. Garage — 1 0 2 0 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
25. H.I.C.R. No.
LOT RELEASED BY Signature HJT a- �s 2on. L_ •
PLANNING BOARD Address 3¢Onfom sf Val- /%k*
Date
MM/3/j3 �iic..
APPLICANT: Diu); S' BUILDING PERMIT Il:
ADDRESS: a.eLacm,., Sli 1/4-1/4). t"f' • TELE. NO. :<b8,367, 917/ DATE FILED:/%3/ 93
BLDG. SITE LOCATION: /(,S /-(k%oM S'/- % Act- MAP/I: 9¢ LOT#: J l3
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. ENGINEERING DEPARTMENT: DATE: N/A:
• 3. CONSERVATION: DATE: N/A:
' 4. HEALTH DEPARTMENT 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:
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' TOWN OF YArtmobTH
• BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE'PRINT: . - '•
• JOB LOCATION:_ /(D$• • (�tfa�l Y& Pe:,--7L
NUMBER . . . STREET . VILLAGE
OWNER OF PROPERTY: ' Gea+.SJ r • 'Msw%-p� iy
CONSTRUCTION SUPERVISOR: r). 0. J • - 09— - --- - 1
NAME LICENSE NO. PHO\E NO.
ADDRESS: '34 ' at,“;;n ' .i-/' • 10. P .)
LICENSED DESIGNEE:
(IF OTHER.THAN SUPERVISOR) NAME •
LICENSE NO.
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 TEAT SUCH LICENSEE IS NO LONGER SUPERVISING
SAID PERSONS, THE WORK SHALL IMAEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS. SUBSTITUTED
' ON THE RECORDS OF THE BUILDING DEPARTMENT. ' ' 11 : -' ' ' •
• I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR LICENSING CCA•
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTA
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
INSURANCE COVCOVERAGE: - . . -..-.. . .-
I have a current liability insurance pclicy or its substantial equivalent which meets the requirements of MGLth.152 'Y.
Yes . ..:No ❑ :: .
If you have checked ves• please indicate the type c'verage by checking the ap.rcpriate box. :-•:-.'-'• ,
.
A liability insurance pcticy Q' '• Other type of indemnity❑ -• Bond 0 ' •----:
OWNER'S INSURANCE WAIVER:I an: aware that the licensee dcei rot have the insurance coverage required tv
Chaoter 152 of the Mass. General Laws, ana that my signature on this permit ::;.ic:icn waves this requirement.
• Check one:
Owners Agent 0
S:gratura of Goner car Owners Agent •
SIGNATURE:nrs-? atries. BUILDING OFFICIAL APPROVAL:
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