HomeMy WebLinkAboutBLD-93-793 ik
� ,*o T 'r TOWN OF YARMOUTH o� r�� PPP/
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'• MATTACMC $ J
4 ..Me•*0 j` Application for a Permit to Build No. 793
UPON FINAL APPROVAL "t jJ0-- /8-q fAP _ 4< LOT 6',2/
FEE MUST ACCOMPANY THIS APPLICATION. DATE7/dO - 19
The undersigned hereby applies for a permit to build /0 /I 93
according to the following specifications /009.3
1. Name of property owner PCd ri riG7 • EUQ Tel. SOS-033o
Address 3c) /UDLr&J/1 tci• W t arnlocttii
2.Name of Architect(if any) Tel.
3. Name of builder O N rtfl_ Address
4. License No. Tel.
5. Name of Mason Address
6. License No. Tel.
L-7: onstructionaddress 30 /Ven TN 16, to.y.
Flood District
8. Date of subdivision Approval plain zone C- Zone /i- Z S
9. Private dwelling * Estimated Cost "e'UP. Q DO NOT WR TE IN THIS SPACE
/044,3 �o,6p. 051r ,o1AJ99 Type of room No.
10. Multi family / etiO -
11. Commercial 0 / /d -* ///04A-`�
kdci.ose ?mot,y y I /� Sp �c/— Kitchen
12. Other ❑ Cu '« S=ens s yRs• ba°) /0 Dining Rm.
13. No. of stories f . Living Am.
Bed
14. Foundation — Full 0 Half 0 Crawl 0 Slab k 07000 B thRm.
15. Materials — Wood g1 Cement 0 Other 0 �0 Deck Ito /,'/3R/-_
16.Type of heat — Oil 0 Gas 0 Electric CZ1 Other 0 Closed porch /
17. Garage — 1 0 2 ❑
no eat No
1_794:-/-- 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.LC.R. No. //��
LOT RELEASED BY Signature /kt Cizu I ii/A//,/
PLANNING BOARD Address 26 4>or // "A'
Date Ea fCUJb(OZ.t1/i
/0/0 . re.ZJ
BUI DING II APPL CATION SIGN OFF
APPLICANT: Altri(44 Evans- BUILDING PERMIT II:
ADDRESS: 30 Axvich f • , to, (16.07 j , TELE. NO. : 7/.7 Q330 DATE FILED: /0 (04
•
BLDG. SITE LOCATION: /1/30i4E MAP//: a S LOT(/: 2/
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 TILE 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 �fa�-^DATE: aggK:"' - 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:
1t(;1/4 (r.)OL I V CS
3L21/39
• a4-mm c q Evans PLOT PLAN •
FOR LOT # 21
. Indicate location of garage or accessory building
Additions with dashed lines
Sewerage disposal (cesspool) e .
Well 0
•
(lot q61 •`d6 ft. rear)
AbutLor's Abutt
Name r4 Name
Lot # • `1 • Lot #
If this is a A01\141/11
I 5c(2 aid If tl •
corner lot, come
write in name writ
of street. [ - < ( ? name
4- • 1 — a ..othe
w • . 0 erZc✓y a stree
m
4 .
SIDE YARD . SIDE YARD
y� ,` HOUSE
Cl_— 3Z FT_ r\ • . • FT.
r1/4
•
CSET B -
•
. . . . ' J.
BhACK.ft. y . .0
[ ,-o
1
1
. 0
(let g 1'`ZS ft. frontage)
/ Nora_ 2d '
/
N / (NAME OF STREET)
. \ \ •
/ \ &J &Eitec, 4/7-end
/ \ Supplied by
/
TOWN OF YAMOUTII
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE 9/0(0/12
JOB LOCATION . .3U . north £00d • L/arli 6601NUMBER STREET ADDRESS SEC ION OF:TOWN
"HOMEOWNER" Patri ii E. Evaiki d'9SZ)33U • 115-01g9
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADRESS ADO VG
•
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 14110 DOES NOT POSSESS A LICENSE, PROVIDED THAT THE OWNER
ACTS AS SUPERVISOR. (STATE BUILDING CODE SECTION 109.1.1)
DEFINITION OF HOMEOWNER:
PERSON(S) WHO OWNS A PARCEL OF LAND ON WHICH IIE/SUE RESIDES OR INTENDS TO RE-
SIDE, ON WHICH TIIEItE 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 THE BUILDING OFFICIAL,
ON A FORM ACCEPTABLE TO DIE BUILDING OFFICIAL, THAT TIE/SIZE 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 REGULATIONS.
THE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH
BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE
WILL COMPLY WITH SAID PROCEDURES AND REQUUIREMENTS.
HOMEOWNER'S SIGNATURE Ai li/G/l /`-• /
APPROVAL OF BUILDING OFFICIAL
NOTE: THREE FAMILY DWELLINGS 35,000 CUBIC FEET, OR LARGER, WILL BE REQUIRED
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 cf MGL Ch. 142.
Yes g No ❑
If you have checked v`s, please indicate the type coverage by checking the appropriate box.
A Itabifty Insurance policy 0 , Other type of indemnity 0 Bond 0
•
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the irsurrce coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this perrnft application waives this requirement.
Check one:
t&Ic/rc A E-O MZ) Owner pj Agent❑
. Synate:a et Q..ner cc Caner s/.;eat — . _ ___. - _
/'utr/Glq EI o is 115--0330 .
130 . VOltE& Rd •
• ' a yaxmouch
.
- EncL c breeuua raz i wit/ 6P oz-e41 ,
169 a/) Center told, %d_c�Dt-Jarilaeachi'.
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Taha/a. , i�l/erior alatls 31/2 inc/ti . (e10s-
f 4Sui _of K_ _c) , c `'. Vent_/ati- j-ah/e s
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Suggested Affidavit for Home Improvement Contractor Permit Application •
t
For Office Use Only" • .; NAME gag/flour/LI-
Date
CITY/TOWN -_
Permit No. we-•�1 Nai noar7 '
�
Date 9140/9q _ !
•
AFFIDAVIT •
Home Improvement Contractor Law
Supplement to Permit Application
MGLc14:.Arequiresthat the ereconstruction.alteration.renovation.reoa ir.modernization.conversion.inprovement.removal.demolition. ---
•
or construction of an addition to anv pre-existing owner-occunied huildingcontaining at least one but not more than fourdwelljn>units....or " •
to structures which are adjacent to such residence or building"be done by registered contractors,with cenain'aeeptions,along with other
requirements. - - - - -- - - - ---- --_
•
Type of Work: e/7GAO.Si>lg (a'ee'lloc,t' • - at. cos# I/Ivo - ---
Address of Work 3A Ajorth1 eel. 10‘t ftZr/en/A
/p
Owner Name: • //Q,friG74 Q• eczaas
Date of Permit Application: JdJ7C�?
•
I hcrcby certify that: ,
Registration is not required for the following reason(s): •
Work excluded by law
Job under 51.000
Building not owner-occupied
(/Owner pulling own permit
_Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN EERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENTWORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL
c. 142A.
•
Siened under penalties of perjury:
I hereby apply for a permit as the aeent 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:
VG2M3 Rabic/i.e. EVA/7,8
Date - - Owner Name
COMMONWEALTH OF MASSACHUSETTS
'_.,SEI`AR MENTOFMIDUSTRIALACCID.EN'TS
— _ -
��' 600 WASHINGTON STREET
James Campoec: BOSTON, MASSACHUSETTS 02111 •
"'omens:one' • - -
WORKERS' COMPENSATION INSURANCE AFFIDAVIT •
•
Patric. uq F. vari,5 •
(licensee/perminee)
• with a principal place of business/residence an
• .�o tict &1• to. yaroarni fA , Ma. caw, •
(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
[ ) I am a sole proprietor and have no one working for mc.
[ ) I am a sole proprietor. genend contractor o omeowner .circle one) and have hired the contractors listed below
• who have the following workers' compensation insurance po ides: -
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number •
Name of Contractor Insurance Company/Policy Number
kI 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
dweiiin; of not more than three uniu in which the homeowner also resides or on the grounds appurtenant thereto are not centrally
considered to be employers under the Worken' Compensation Act(GL C. 152,sect. 1(5)),application by a homeowner for a license
or permit may evidence the fecal stains 012.13 employer under the Workers' Compensation Act.
1 undo.^.sand that: copy of this statement will be forwarded to the Department of Industrial Accidents'Office of Insurantx for coverace
_' verification and that failure to Lure covcnze as required under Section 25A'of MGL 152 can lead to t:.e imposition of criminal penalties
consisting of: fine of up to 51500.00 and/or imprisonment of up to one year and dvii penalties in the form of:Stan Work Order and a
fine of 5100.00 a day against mr..
Signed this • a O TA" day of $ Septelli 19 7? •
•
L.c_r•.souP:rrn:-c.