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Home My WebLink AboutBLD-93-790 4-(it ° 7-1VI Y x ok 10I P5 i$ ', o TOWN OF YARMOUTH 0 ftp olVil • MATT .s is 5 Al V,Z°. ss• f./ Application for a Permit to Build No. '7 vo a )0 ,/, -q-.5 p L fr UPON FINAL APPROVAL MAP �0 LOT /�,57-� FEE MUST ACCOMPANY THIS APPLICATION. DATE /6 6 19 C-3 The undersigned hereby applies for a permit to build /d/079-3 according to the following specifications/ W/5 1. Name of property owner ./Zcv/.4 4 tg Al 6-N Tel.77(93to Address 90efria- ie, eeresl9. .moi 2.NameofArchitect(ifany)W w�P `sr enn' ezf6 ��5 ' Tel. ' a Name of builder //,L/, Cc-t,€47r) Address ASLti.-« C ye.o, 22,72.7cf 4. License No. Tel. .1,V ci? y 5. Name of Mason Address a License No. Tel. 7. Construction address 6:7° 409-ee^- /1--.O ea--e-5-4-y o7, ✓J) Flood Diostrict 8. Date of subdivision Approval cp a zone Znecgs- 9. Private dwelling CO/ Estimated Cost /0-'i/43 DO NOT WRITE IN THIS SPACE 'ag , �o'� /0 Da Type of room No. 10. Multi family ❑. �.+a�- "O 11. Commercial 0 k% `e2y 5 Kitchen m 12. Other ❑ ��. a'^-- Dining Rm. — 13. No. of stories ,e9- /0_o-o- ,/`Living Rm. ,Bed Rm. 14. Foundation - Full L>a' HIf 0 Crawlwl0 Slab 0 7 q01 00 Bath _ 15. Materials - Wood R'Cement KI ther 0 Deck _ 16. Type of heat - 0' 0 Gas 0 Electric 0 Other 0 Closed porch Family Rm. 17. Garage - 12 ❑ 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 "7C No. of feet rear 7C No. of feet deep /a r 22. Size of building. No. of feet front 60 No. of feet side 30 No. of feet rear 6 0 23. Distance from nearest building: Front Ft. side /A Ft. side ___ ___ Rear 6b 24. Distance back from line or street VS From rear lot line Sr° Side line 'f 25. No. ( ,�J ( �2 LOT RELEASED BY Signatur //Lc�.�-- PLANNING BOARD Address 96 de-Er,t. Xc Date v-c_r7 f4t' ,d .-flj ,0l (0/93 TOWN OF YARMOUTH BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE / - 'i - 93 JOB LOCATION co 69/EC.-- ,C0 T yell,.(.4-4 NUMBER STREET ADDRESSECTION OF TOWN .339 -6af f. ,irfc to "HOMEOWNER" � it t/677c.1 71573/0 5337 ,y,t NAME HOME PHONE WORK PHONE . PRESENT MAILING ADDRESS A old x 6 len pi,5he47 `ijrasi Oa°ye- 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 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/SHEEgILL C LY WITH S ID PROCEDURES AND REQUIREMENTS. HOMEOWNER'S SIGNATURE .s,. ( ��jyyu-r APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 0 Other type of Indemnity ❑ Bond 0 OWNER'S INSURANCE WAWER:.I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner 0 Agent 0 Signature of Owner or Owners Agent • • • • .1 • 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 111, S • 150A. The debris will be disposed of in: • Location of Facility) • • • CY Signature o Permit Applicant Date • • • • • AFFIDAVIT As a result of the provisions of MGL c 40, S54, I acknowledge that as a condition of Building Permit Number all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. • • I certify that I will notify the Building Official by (T'vo months maximum) of the location of the solid waste disposal facility where the debris resulting from the said construction activity shall be disposed of, and I shall submit the appropriate form for attachment to the Building Permit. ge‘rg•—• / Date Signature of Permit Applicant (Print or type the following information) way) L Name of Permit Applicant • • Firm Name, if any 90 6il,Ca a- ,Co c— ej Address • :ter COMMONWEALTH OF MASSACHUSETTS _ DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET • James J Ca rappel; BOSTON, MASSACHUSETTS 02111 • con^,,msstoner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • (licensee/permittee) - • with a principal place of business/residence at.. • (City/Sure/Zip) — do hereby certify, under the pains and penalties of perjury, that: - . ( J I am an employer providing the following workers' compensation coverage for my employees working on this job. • Insurance Company Policy Number ( J I am a sole proprietor and have no one working for me. ( m a sole proprietor, general contraaor or omeown . (circle one) and have hired the contnaors 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 Q 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 for a license or permit may evidence the legal sums of an employer under the Workers' Compensation Act. I understand that a copy of this statement will be forwarded to the Department of Industrial Accidenu' Office of Insurance for coverage verification and that failure to iccure 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 penalties in the form of a Stop Work Order and a fine of 5100.00 a day against me. Signed this 2u�� .0 — --- day of 70 — , 19 Licensee/Permit-tee' LicensoriPermiror " Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only NAME OF CIWI'OWN Permit Na t�/C t 7.91-01o emsy'4 Dek AI•NIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.142A requires that the"reconstruction.alteration.renovation.repair,modernization.conversion.inprovement,removal,demolition, or constriction of an addition to anysre<xisting owner-occupied huilding_containing at least one hut 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. pGJ . Type of Work: Ciro G/ .?7 n U ea t°— Est. Cost 9U Address of Work 90 Sa,ee/r— w4$' �.0,1---1,o eyg Owner Name: lel ,.9,2iC.'1 Date of Permit Application: to -4-93 I hereby certify that: -- Registration is not required for the following reason(s): - _Work excluded by law Job under S1,000 _Buil • g not owner-occupied ner 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 a permit as the owner of the above property: % i5 l�;en—(Y/ Date Owner Name Lie.? APPLICANT: w/n e..1 BUILDING PERMIT //: ADDRESS: qp \AM. TELE, NO. : '725-23/0 DATE FILED: 0 6-5S " BLDG. SITE LOCATION: 20 e.g,&.L '_ �L/J MAP#: lLOT/1: "IS""IS" l 7 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 TbCE OF 11 CA) WATER DEPARTMENT: DETERMINES COMPLIANAN E OF WAR 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: REVIFFWED BY: Pl. WATER DEPARTMENT a„ 2.. q,� CN) DATE: 1(!) -&-' 3 N/A: 2. ENGINEERING DEP TMENT: / I DATE: N/A: • 3. CONSERVATION: Pat DATE: �U— N/A: 4. HEALTH DEPAR ' T • r DATE: /0-7-( j� N/n 5. HISTORICAL !bre /,v DATE. 7p-7-Ts N/A NDUSTRIAL AND/OR COMMERCIAL PERMITS • 5. WIRING INSPECTOR: / 20,eammr DATE: OCT - 6 1993 N/A: 6. PLUMBING INSPECTOR `. DATE://4 .- 7 - 93 N/A: 7. FIRE DEPARTMENT: '1 r !i (�� - DATE: /0/6/73 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: b. er - Q _ TO Dein rL r . apse bot1 t•)/ 11 . 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