HomeMy WebLinkAboutBLD-93-789 .,uF•IrgR d I-( A.-I 1° Gl
f =�'o TOWN OF YARMOUTH0 `�
,• HAnACHEES 4'4,t /g9
,< .,SSO Application for a Permit to Build No. /
UPON FINAL APPROVAL &�� /0-45-15 MAP a 9' LOT k. — 4
FEE MUST ACCOMPANYTHISRPPLICATION. DATE den 1/ 19 73
The undersigned hereby applies for a permit tobuild
� `��/.5/93
according to the following specifications Cff v „ p_ s
me of property owner i1-A- tl F LL'/ in,& AEI1L ) P A224--1P71.4 322o
Address 2?, 154Si IRiUFR Fkw y 5. 74RhOvlf S'tl,c Y.c Tal y
2.Name of Architect(if any) Tel.
1,3! Iameofbuilder W it-tm t 03nYn/E Address big.5km/6tt W U) Y44/Y0LJR1
4. License No. P) 1 go f 7 Tel. 77' .i 292
5. Name of Mason Address
6. License No.- Tel.
IYConstructionaddress 2.3 PIAss RI0Fl? PKwV 5 Y4+111 eon/
FloodDistrict
8. Date of subdivision Approval plain zone '— Zone 7-7
g .0
9. Private dwelling 0 Estimated Cost -tar' ' DO NOT WRIZE IN THIS SPACE
10. Multi family 0 W 5000t ad rs�q-�� NO=
Type of room No.
11. Commercial ❑ �0 t /fin 1
- Kitchenr.. . o-..._ ,a-K bee./( t
12. Other mee Hair - a w r.=2 /0 V a V °°; Dining Rm.
13. No. of stories I I ,cosi omee, 5$f: 1=r- Living Rm.
e Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 '07g-
Bath
15. Materials — Wood 0 Cement 0 Other 0 9''dO Deck 01l ji
16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 u°ak 55;(5D Closed porch
17. Garage — 1 ❑ 2 ❑ >4# ! -----7--z );-E—D Family Rm.
n room.
18. Swimming pool - Size �0 , u d '� arage
19. Storage shed — Size -1 / a/'a-c— 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. t At-,I 2 4LOT RELEASED BY Signature .� e 4
PLANNING BOARD Address .73& Av/DUFF , 5r U//
Date GDW; LL, t/4 • D Air Z
to/y/f3w1
•
October 4, 1993
Location: 23 Bass River Parkway, S. Yarmouth, MA.
Owner: John Reilly
Raise or construct a dormer on garage *2 for a recreation room
and viewing of Bass River, with 4 ' x 13 ' deck or balcony,
dormer to have a 8 ' slider door, 1 window on each side,
wood paneling on inside, insulated, no heat, no water,
garage below will be sheetrocked to comply with fire
code, stairwell from inside of garage will be closed
in with door
Suggested Affidavit for Home Improvement Contractor Permit Application
For Orrice Use only . . _ - NAME OFnC�ITY/I'OWN
nate It No. y4.Q/2 aci fl( !74
• AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGLc.142A requires that the"reconstruction.alteration.renovation,renain modernization•conversion,inprovement,removal.demolition.
orconstruction clan 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 building"be done by registered contractors,with certain exceptions,along with other
requirements. -
e of Work: •
EYPn.neatii /tto ilberosp e-but77-Iv Est: Cost tfO0� -•
Address of Work ' 3 64 S5 AI 1a pkwy 6. Yarm 0f tl
Owner Name: L/ayN/Z c / L7
•
Date of Permit Application: )9d? 4113
•
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 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:
Date Contractor Name
Registration No.
OR: •
•
Notwithstanding the above notice, I hereby apply for Ate
mit asthe owner of the above property:
iQ/V/9 V €t 44,; . 4
Date j "&pwncr- kern L��
TOWN OF YAMOUTII
BUILDING DEPARTMENT
HOMEOWNER LICENSE 'EXEMPTION
PLEASE PRINT:
DATE
JOB LOCATION ).3 3/}is QIVft Pkwy Socrx YAP-Amu rri
NUMBER STREET ADDRESS SECTION OF.,TOWN
"HOMEOWNER" el-4f4F G RE[LLy Sof Ys-ii *fifty'
NAPE HOME PHONE WORK PHONE
PRESENT MAILING ADRESS 730 ArJJ1p EA, jr
Lou)Ec-(. MA 0 /f5.2
CITY OR TOWN STATE ZIP CODE
•
THE CURRENT EXEMPTION 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 W110 DOES NOT POSSESS A LICENSE, PROVIDED THAT THE OWNER
ACTS AS SUPERVISOR. (STATE BUILDING CODE SECTION 109.1.1)
•
DEFINITION OF HOMEOWNER:
PERSON(S) W110 OWNS A PARCEL OF LAND ON WHICH HE/SHE RESIDES OR INTENDS TO RE-
SIDE, ON WHICH 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 TUE BUILDING OFFICIAL,
ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT HE/SUE SHALL BE RESPONSIBLE
FOR ALL SUCH WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1)
TILE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH THE STATE
BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGULATIONS. •
•
THE UNDERSIGNED "110: OWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH
BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND TEAT BE/SHE
WILL COMPLY WITH SAID SAPROCEDURES AND, REQUI• a I NTS.
HOMEOWNER'S SIGNATURE!/ �f ' _ Cep , tette ,�3tz&-^ 7-74cC�-�
APPROVAL OF BUILDING OFFICIAL •
(/
NOTE: THREE FAMILY DWELLINGS 35,000 CUBIC FEET, OR LARGER, WILL BE REQUIRE)
TO COMPLY WITH STATE BUILDING CODE SECTION 127.0, CONSTRUCTION CONTROL.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes 49 No ❑
If you have checked vves, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy I Cther type of indemnity 0 Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverace required ay
Chapter 142 of the Miss. General Laws, and that m signature on thispermit', appli-,tion waives this requirement.
Gene I L.. Y � rr q�
-/ • *meek one:
Sr;nal:c.^_ ci Cater cc Cerner s'/cent _. . . - ___ -
•
iJ
'= -' COMMONWEALTH OF MASSACHUSETTS
ei DEPARTMENT OF INDUSTRIAL ACCIDENTS
•
. 600 WASHINGTON STREET
•
James J Camvoei BOSTON, MASSACHUSETTS 02111 •
Comm,ss ones WORKERS' COMPENSATION INSURANCE AFFIDAVIT •
•
I,
(licensee/permuee)
• with a principal place of business/residence at: -
(City/State/Zip)
do hereby certify, under the pains and penalties of perjury, that:
•
( 1 I am an employer providing the following workers' compensation coverage for my employees working on this
job.
/.0/9 (Li 4t& ISIY000 0610 SG
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: „, ----c• _ ._ : _
Name of ContractorInsurance Company/Policy Number . .
Name of Contractor - Insurance Company/Policy Number . •
-
•
Name of Contractor Insurance Company/Policy Number _
Q 1 am a homeowner performing all the work myself.
NOTE..PIeue be awue 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(CL C. 152.sect. 1(5)), application by a homeowner for a license
or permit may evidence the legal sums 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 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 5 100.00 a day against me.
Signed this 7' day of 07 , 19 5
Liee^seeiPer.r:it:__ Liceas ri ermV.r
. ,
,,./..
YOUR SEWERAGE SYSTEM INSTALLED:BY:
• . tvi:-.441/4
-,. Name Witt/Jon /4,V6-ir 4.-4 Permit Na:
.
- Street .3° 4/
ST /71 I re S'a „,41-77/ Date Vizs Sb -
TOWIt a%t,rfre ) 4. OH? ed r/Y
• .- Size of Septic Tank boo Gal. Leach Pit 2- too Gal
stb0/4-- c•e'vee
Leach Field ft. x • • ft. Other
Inert Materials Should Be Pumped Out Periodically
See Paragraph A-3 (over)
LOCATION OF SYSTEM
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E; Tho inspection was I FURTHER STATE THAT IN MY PROFESSIONAL
�l for mortgage purposes and Is not b be rolled �` OPINION�° a°inward..ndaxeuory •
as a survey. Northern Associates, Ina.eooepts no NstM oti�2M
onsib Dty for damages resulting from said reliance /�1 •
C
net
with other than
the � Tommie:,aiee and ha assigns by •i•ty�/ - • c _ ,� r o dth an setback requirementsreare of i
orclrtartoes,and that there no encroachments of mr
PLOT PLAN
FOR LOT if •
Indicate location of garage or accessory building •
Additions with dashed lines
Sewerage disposal (cesspool)
. Well 0 .
I .
•
I (lot ft. rear)
Abuttor's I Abutt
Name I Name
Lot ,", I • Lot #
REAR YARD
If this is a If th
corner lot, ft. • cornc
write in name writ
of street. I name
• • I • cz other
v strec
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.. . • • to
4 •
SIDE YARD SIDE YARD
• . HOUSE
•
FT. 0 40 FT.0. •
0 .
• • • I .
• I .
• •
• SET BACK
•
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• ft. �,
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(lot ft. frontage) ..
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\ / (NAME OF STREET)
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/ \ -information
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I mmumPERjTiy1CATION SIGN OFF
•
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APPLICAeMT: Ets_ rtJf 6. "{Ear/ BUILDING PERMIT //:
ADDRESS:. ,23 - bWSS IRIU✓Q trial TELE. NO. : 760 J'ZZp DATE 'MED;
6 Y-/�1-'wove -
BLDG. SITE LOCATION: 23 pos.4 Iiv,SJL /KwV NAP#: 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. ENGINEERING DEPARTMENT: DATE: N/A:
3. CONSERVATION: DATE: N/A:
4. HEALTH DEPARTMENT DATE: /Uj3J93 N/A:
NDUSTRIAL 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:
f,cc4 o1. No uu
a,) INSULn'r `To co-?,e--
tot,
tot, o&DtraniznyarK . ow / CK ic/ rhv. C/o/=F • quo
Sta .a . i
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